Localized Cutaneous Argyria

Abstract

We report 2 cases of patients who presented with blue macules clinically suspicious for blue nevi. One patient had no documented history of trauma or silver exposure, and the other reported exposure to silver over 30 years ago. Microscopic examination revealed a dermal population of brown-black globules predominantly adhering to collagen fibers. In both cases, no melanocytic proliferation was identified by immunohistochemistry. Analysis of the skin biopsies with scanning electron microscopy and energy dispersive x-ray spectroscopy demonstrated the presence of silver and selenium. These findings were diagnostic of localized cutaneous argyria. Our case reports highlight the importance of including localized cutaneous argyria in the differential diagnosis of pigmented lesions.

A clinical mimicker of melanoma with distinctive histopathology: Topical silver nitrate exposure

“…4,9 However, since the medicinal use of silver has declined over the most recent years, contemporary argyria is rare. 4,8,10 More commonly, limited exposure to silver via external contact results in reversible skin discoloration, as seen in our cases. Localized skin discoloration has been described following exposure to silver via topical silver nitrate, silver-coated wound dressings, silver earrings, implanted acupuncture needle fragments, control of hemorrhage during cervical biopsy, treatment of oral ulcers, and occupational exposure.…”

“…Generalized, irreversible skin discoloration due to silver exposure has been referred to as argyria, which develops following long‐term drug therapy or occupational exposure 4,9 . However, since the medicinal use of silver has declined over the most recent years, contemporary argyria is rare 4,8,10 . More commonly, limited exposure to silver via external contact results in reversible skin discoloration, as seen in our cases.…”

“…The cases presented had multiple specific histopathologic features that when taken together with dermoscopy are most consistent with exposure to topical metal‐containing substance and rule out the clinical differential diagnoses. Although the clinical appearance can be concerning for melanoma, 7,8 the characteristic histopathology rules out malignancy. Silver nitrate is a commonly used topical metal‐containing substance, and clinical history of exposure to silver nitrate is supportive.…”

Clinical and Forensic Aspects of the Different Subtypes of Argyria

“…Argyria is often overlooked as a differential diagnosis of pigmented lesions, given its rarity [ 8 , 45 , 83 , 164 ]. Any of these findings might correspond to argyria: a slate-gray/bluish change of the complexion in sun-exposed areas, localized dark-blue lesions, eye gray/brown/dark spots or conjunctival pigmentation, or the characteristic nail changes seen in azure lunula [ 34 , 46 , 48 , 61 , 73 , 82 , 115 , 165 ].…”

“…The timespan for the onset of the pigmentation might vary from days to several years, and it then becomes ever lasting, making the diagnosis of argyria not discardable regardless of the amount of time passed since exposition and first-time pigmentation observation [ 8 , 81 , 83 , 87 , 134 , 164 , 165 , 188 , 222 , 244 ]. These should prompt a thorough anamnesis to ascertain if there is any kind of pathological or toxicological justification for these alterations and to establish a differential diagnosis ( Table 2 ).…”