Cutis rhomboidalis nuchae is a particular type of
solar elastosis of the dorsal neck with thickening of the epidermis (14).
Solar elastosis results in the destruction of the coherent mechanically strong and protective fibrous network of dermal collagen, and the substitution of an amorphous gel-like elastotic material.
Several prominent dermatologists in recent years have argued that
solar elastosis is coincidental with a melanoma diagnosis, not contributive, and is related only to patient age.
Solar elastosis was present in 60% of the Canadian patients, and 64% of the melanomas were in a vertical growth phase when they were removed.
Solar elastosis has been shown to be secondary to the synthesis of alpha-melanocyte stimulating hormone (alpha-MSH) and adrenocorticotropic hormone (ACTH) derived from pro opiomelanocortin (POMC) in keratinocytes.
In sharp contrast to lentigo maligna, there is only limited or no
solar elastosis. Focal pagetoid spread of single melanocytes (but not melanocytic nests) is usually present, but this may not be a prominent finding.
Mean age of the patients correlated significantly with the presence or absence of
solar elastosis (70.1 [+ or -] 5.8 v 55.2 [+ or -] 16.2 years; P=0.01) and splinter haemorrhage (61.8 [+ or -] 13 v 52.2 [+ or -] 16.7 years; P=0.018).
In the dermis, there may be collagen degeneration that appears similar to
solar elastosis.
Because of the imperfect wound repair of the damaged collagenous matrix and the accumulation of elastotic material, known as
solar elastosis or solar scar, the skin eventually sags and wrinkles after chronic LTV exposure.
The overlying epidermis showed no cytologic atypia; however, there was moderate
solar elastosis.