DOI: 10.1111/pde.

13591

Pediatric
BRIEF REPORT Dermatology

Molluscum contagiosum arising in a melanocytic congenital

nevus
Abstract
Molluscum contagiosum within a congenital melanocytic nevus has
rarely been reported. We report a 6-year-old child with molluscum
contagiosum infection arising within an intermediate melanocytic
congenital nevus of the thigh, associated with itching and occasional
bleeding. Dermoscopy lead to the correct diagnosis, but histologic
confirmation with shave biopsy was performed to reassure the par-
ents and allow mechanical removal of the lesions using curettage.
1 | INTRODUCTION
Molluscum contagiosum (MC) is a common skin infection caused by a
DNA virus. Diagnosis is typically based upon clinical examination. Der-
moscopy is also a useful diagnostic tool to confirm clinical suspicion,1
but histologic examination is sometimes needed in atypical presenta-
tions and when associated with other skin diseases or neoplasms.2
The association between MC and congenital melanocytic nevus
(CMN) has only rarely been reported.3,4 We present an additional
case.
2 | CASE REPORT
A 6-year-old, otherwise healthy boy was followed regularly for a
medium-sized CMN on his left thigh (Figure 1A). He was urgently
referred to our clinic because of a 1-month history of new itchy
bumps within the nevus that occasionally bled. On examination, six
dome-shaped papules, pink to flesh-colored, measuring 0.1 to
0.5 cm, some covered with hemorrhagic crust, were located exclu-
sively on the surface of the nevus (Figure 1B). The nevus
(15 9 8 cm) was otherwise stable, with terminal hair and a dermo-
scopic globular pattern with brown cobblestone globules and regular
palpable areas of darker pigmentation. Dermoscopy of the eruptive
lesions showed central white to yellow amorphous structures with a
peripheral crown of reddish, linear, or pointed vessels (Figure 1C).
Clinical and dermoscopic evaluation was consistent with the diagno-
sis of MC. We performed curettage of the lesions and sent a shave
biopsy for histopathologic examination, which showed dermal mela-
nocytic proliferation, cutaneous hyperplasia, and multiple lobules of
keratinocytes, with abundant cytoplasm, peripheral nuclei, and viral
inclusions (Figure 2A-C). Once the correct diagnosis was confirmed,

(A) (B)

(C)

F I G U R E 1 (A) Melanocytic nevus of

the tight in a 6-year-old old male patient
(B) dome-shaped papules, pink to flesh-
colored, measuring 0.1 to 0.5 cm, some
covered with hematic crust on the surface
of the MN (C) Dermoscopy: central
polylobular white to yellow amorphous
structure with a peripheral crown of
reddish, linear or pointed vessels, within
globular pattern with brown cobblestone
globules

Pediatric Dermatology. 2018;1–2. wileyonlinelibrary.com/journal/pde © 2018 Wiley Periodicals, Inc. | 1

2 | Pediatric BRIEF REPORT
Dermatology
dysfunctions and fragility, manifesting as superficial erosions, ulcera-
(A)
tions,4 or predisposition to dermatitis as Meyerson’s phenomenon.5
Accordingly, CMN might be more prone also to skin infections such
as MC. Furthermore, MC infection arises in CMN of several centime-
ters in diameter and located on surfaces prone to friction,3,4 corrob-
orating the role of a compromised epidermal barrier. Physician
awareness of this association can allow for recognition and appropri-
ate management.

Keywords
dermatopathology, infection-viral, nevi-melanocytic

ORCID

Laura Atzori https://orcid.org/0000-0002-8105-1402

Marialuisa Corbeddu http://orcid.org/0000-0002-4158-5717
Luca Pilloni https://orcid.org/0000-0002-1420-8887
Franco Rongioletti https://orcid.org/0000-0002-2227-581X
(B) (C)

Laura Atzori MD1

Marialuisa Corbeddu MD1
Marzia Mou MD2
Luca Pilloni MD3
Franco Rongioletti MD1
1
Section of Dermatology, Department of Medical Science and Public
F I G U R E 2 (A) Photomicrograph of a shaving biopsy Health, University of Cagliari, Cagliari, Italy
(haematoxylin-eosin stain) showing dermal melanocytic proliferation, 2
Private practitioner, Jerzu, Italy
multiple lobules of keratinocytes with abundant cytoplasm, peripheral 3
Section of Pathology, Department of Surgery, University of Cagliari,
nuclei, and viral inclusions with also cutaneous hyperplasia. (B) Larger
magnification of viral inclusions (C) Melanocytes disposed into nests Cagliari, Italy
in a benign morphology
Correspondence
Marialuisa Corbeddu, MD, Section of Dermatology, Department of
lesions were mechanically removed using curettage. After 1 year, no Medical Science and Public Health, University of Cagliari, Cagliari, Italy.
relapses have occurred. Email: marialuisa.corbeddu@gmail.com

3 | DISCUSSION
Change in CMN can be a worrisome finding, especially if associated
with rapid growth, itching, or bleeding. Multiple eruptive lesions sug-
gested an infection, but despite the frequency of MC in children,
occurrence within a melanocytic nevus is uncommonly reported,2-4
even less so in CMN.3,4 Dermoscopy is useful to address the differ-
ential diagnosis,1 but histologic confirmation with shave biopsy is a
simple procedure that leaves no doubt regarding diagnosis. Treat-
ments, such as cryotherapy, curettage or topical agents may further
modify nevi, leading to scars, recurrence, or superinfections. MC
within CMN may be more frequent than reported. In CMN, prolifer-
ation of melanocytes within the dermis can lead to barrier
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