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Localized cutaneous argyria is a rare condition secondary to skin deposition of silver following exposure to substances containing this metal. The clinical appearance and dermoscopy findings require deep melanocytic lesions and particularly melanoma metastasis to be ruled out. Silver deposits are usually confirmed by scanning electron microscopy and/or energy-dispersive X-ray spectroscopy. Herein we describe the in vivo reflectance confocal microscopy (RCM) features observed in one case of localized cutaneous argyria. These features include the presence of a hyperrefractile network in the papillary dermis and a periadnexal dotted bright pattern. In vivo RCM might be a useful tool for an early diagnosis of this uncommon entity.

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PURPOSE: To determine the value of confocal and specular microscopy in the examination of corneal argyrosis in art silver solderers. METHODS: Six patients with corneal argyrosis underwent a complete physical and ophthalmologic examination. Specular microscopy was performed in three cases, and in vivo confocal microscopy in four cases. Ultrasound biomicroscopy and corneal topography were performed in three cases. A conjunctival specimen of one patient was examined histologically in paraffin sections. RESULTS: Slit-lamp examination showed gray, diffuse opacities in the deep corneal stroma. Confocal microscopy showed highly reflective deposits with a granular pattern anterior to the corneal endothelium and hypereflective keratocyte nuclei with visible cytoplasm in the anterior stroma. Specular microscopy demonstrated round white bodies anterior to the corneal endothelium. Silver deposits were not found histologically. CONCLUSIONS: Silver solderers with long-term exposure to silver compounds are at high risk of developing corneal argyrosis. We conclude that specular microscopy and in vivo confocal microscopy provided important information for the diagnosis of corneal argyrosis.

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We describe a case of focal argyrosis of the conjunctiva clinically simulating a melanoma. An 82-year-old woman was referred for an asymptomatic pigmented conjunctival lesion. Her only significant past ocular history was strabismus surgery 76 years earlier. Biopsy of the conjunctiva and lateral rectus muscle revealed the discoloration was pigment granules. Energy-dispersive x-ray microanalysis revealed the pigmentation to be silver deposits. The patient had strabismus surgery probably using a silver clip. Argyrosis should be considered in the differential diagnosis of focal pigmented conjunctival lesions.

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Using a simplified tissue processing method for X-ray microanalysis, we have characterized the elemental composition of silver-laden granules deposited in the skin of two patients with argyria. The introduction of ethanol as a fixative and nylon mesh as a supporting grid, and the avoidance of electron staining, have facilitated the minimization of unwanted microanalytical emission peaks generated from conventional chemicals and metals, which often disturb precise clarification of elements of pathological interest in argyria. The two main X-ray microanalytical findings in this study were: (i) the consistent presence of sulphur and the inconsistent occurrence of selenium in the silver-laden granules, and (ii) successful mapping of the distribution of trace amounts of selenium present in argyria. The simplified tissue processing method could be useful in future critical X-ray microanalysis studies.

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A case of localized argyria with chrysiasis caused by implanted acupuncture needles in a 41-year-old Japanese woman was studied by electron microscopy and x-ray microanalysis. Large amounts of silver granules with selenium and sulfur were detected around eccrine secretory cells in much greater amounts than around ductal cells. Many granules were also observed along the outer edge of the basement membrane but never within cells or intercellular spaces. The granules were also present around blood vessels, lymphatics and nerve fibers, and in elastic fibers. Small numbers of gold fragments were also seen, mostly within macrophages. These results suggest that silver deposits extracellularly as selenide and sulfide, whereas free gold is found intracellularly.

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Acupuncture needles implanted in the skin for more than ten years caused peculiar bluish macules, each of which clinically resembled a blue nevus in the extremities of a 63-year-old Japanese woman. Histologically, the involved skin showed deposition of fine brownish granules in the basement membrane of the eccrine sweat glands, on the inner surface of the blood vessel walls, and along elastic fibers of the superficial dermis in addition to sparse deposits noted throughout the dermis. Electron microscopy revealed deposits of electron-dense particles on the basal lamina of the secretory coils of the eccrine sweat glands, below the basal lamina of the dermoepidermal junction, and on elastic fibers. Roentgenographic microanalysis of the involved skin demonstrated that most of the granules consisted of silver and chloride; silver was a major component in the removed needles.

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The article presents two methods for the theoretical determination of CT values. These methods involve relatively little work and cost and enable at least an estimation of the CT value of any object to be examined. The results are compared with the experimental data, and possible sources of errors are shown. The article concludes with a discussion of a few examples from actual practice.

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