In dermal melanocytoses such as blue nevus or nevus of Ota, an ultrastructural study has demonstrated an intimate relationship between the dendritic melanocytes and the dermal elastic fibers with elongated cytoplasmic processes of the melanocytes aligning lengthwise along the axis of the elastic fibers in longitudinal sections and encircling the elastic fibers in cross-sections. Such a close arrangement has not been reported in common melanocytic nevi. The current case described a similar arrangement between the melanocytes and the dermal elastic fibers in a usual intradermal melanocytic nevus. Of note, as the melanocytes matured with descent, the deep melanocytes were arranged in single cells embracing the elastic fibers, imparting a signet-ring cell/phagocytosis appearance. A Verhoeff-van Gieson stain showed hypertrophy of the melanocyte-associated elastic fibers compared with the elastic fibers in the dermal background, suggesting a paracrine or juxtracrine interaction between the melanocytes and the dermal cellular components. Because of the distinctive affinity of the melanocytes to the dermal elastic fibers in this melanocytic lesion, the term melanocytic nevus with elastophilic features is suggested for this peculiar melanocytic variant.
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