A 38yearold woman presented to clinic with a solitary 6. We suspected that it was a blue nevus or a pigmented reedspitz nevus. Scalp is a classical site of cellular blue nevus that shares many features with common blue nevus 4,5. May 22, 2007 histopathology skin cellular blue nevus. The blue nevus is found most frequently on the skin. Melanocytes are derived from the neural crest and migrate during embryogenesis to selected ectodermal sites primarily the skin and the cns, but also to the eyes and the ears. Blue nevus it is a small slate blue to blue black macule or papule found in the extremities, acquired after infancy. Atypical cellular blue nevus presents an intermediate histopathology between the typical and a rare variant of malignant blue nevusmelanoma arising in a. Blue nevus bn is a common specimen in routine pathology practice.
Genomic copy number analysis of a spectrum of blue nevi. Soepronos textbook is available on and includes detailed information on over 600 entities and includes four dvd diskettes with highresolution images that provide a virtual dermatopathology reference and guide. Triggering events can include bullous processes such as erythema multiforme 2 and stevensjohnson syndrome, 3 severe sunburn, 4 trauma, 5. These lesions may cause diagnostic difficulty in case of large size, involvement of subcutaneous tissue, asymmetrical pigmentation and presence of lymphnode metastasis.
A histological diagnosis of cellular blue nevus with satellitosis was then rendered. Combined cellular blue nevus and trichoepithelioma is a rarely reported but distinctive biphasic tumor. Pdf atypical cellular blue nevus or malignant blue nevus. Pdf extensive intraoral blue nevus case report researchgate. These are defined as blue nevi, most often of the cellular type, in which histo pathology shows one. Jul 27, 2016 a blue naevus is a small blue or greycoloured lesion of the skin, with an appearance similar to a mole. In recent years, several histopathologic variants of blue. Sf3b1 and bap1 mutations in blue nevuslike melanoma modern. The compound variant of blue nevus can be distinguished histologically from combined blue nevus, pigmented spindle cell nevus, malignant melanoma, and melanosis due to a regressed malignant melanoma. Maturation in the context of melanocytic lesions means 1 the cells get. On dermoscopic observation, the lesion showed homogeneous blackbluish pigmentation, suggesting a substantial amount of melanin in the dermis. The distinction of a cellular blue nevus with atypical features from melanoma can be difficult. Care should be exercised to exclude nonmelanocytic lesions, and benign melanocytic entities, both of which can mimic melanoma histologically. Histological diagnosis of nevi and melanoma guido massi.
Atypical cellular blue nevus or malignant blue nevus. Pdf blue nevus versus pigmented epithelioid melanocytoma. Melanocytic lesions are commonly encountered in dermatopathology and an area which causes some difficulty, i. The interpretation of melanocytic tumors represents probably the most difficult task in the field of dermatopathology.
A and b, classic example of blue nevus showing dermal sclerosis desmoplastic blue nevus and admixture of dendritic cells and type b melanocytes. The second edition of this text and atlas depicts a broad range of the most important and most challenging melanocytic lesions. Cellular blue nevus, however, are typically larger in size at least 1 cm in diameter, and more nodular. They derive their blue colour from their pigmentation with melanin and relatively deep position within the epidermis. Histopathology skin compound clarks nevus dysplastic nevus this feature is not available right now.
Nevus or nevi if multiple is a nonspecific medical term for a visible, circumscribed, chronic lesion of the skin or mucosa. Nevus of ota nevus fuscoceruleus ophthalmomaxillaris is a bluegray or brown irregular, often spotted skin discoloration located on the face in the distribution of the first and second branches of the trigeminal nerve i. It less often presents on the forehead, upper outer eyelids, and nose. Among the 3 variants of blue nevi, the cellular variant occurs less frequently than the common and combined variants.
A variety of clinical and histological appearances may be assumed, some of which can be worrisome both to the clinician and pathologist, with the most difficult differential diagnosis, in some instances, lying with malignant. Trichoblastoma is the most common neoplasm developed in nevus sebaceus of jadassohn. Eruptive blue nevus is an exceptionally rare subtype of blue nevus with few cases reported since the 1940s. Gnaqgna11 mutations have recently been found in various forms of blue naevi. The common blue nevus is the second most common variant. The main tumor cells of common blue nevus are elongated, dendritic melanocytes with reactive melanophages and only a few. Apr 14, 2017 the genetic similarity between blue nevi and uveal melanoma has been further demonstrated by a number of recent studies reporting bap1 mutations or protein loss occurring in blue nevus like. This dermoscopic feature was suggestive of a blue nevus. May 22, 2007 histopathology skin compound clarks nevus dysplastic nevus this feature is not available right now. Affected individuals have one or more nevi that vary in size. Nevus cells do not have dendritic processes, except for those within blue nevi. Atypical cellular blue nevus presents an intermediate histopathology between the typical and a rare variant of malignant blue nevusmelanoma arising in a cellular blue nevus. An 8yearold child presented a pigmented lesion in the buttock since birth, but with.
Dermal melanocytoses form a spectrum of benign intradermal melanocytic lesions composed of dendritic melanocytes, the most common of which is the blue naevus. Melanocytes, nevus cells or melanoma cells, each of. A hypomelanotic blue nevus, an uncommon variant, generally presents clinically as a depigmented papule with focal residual blue brown pigment. It is considered by some to be a variant of melanoma, whereas others view it as a distinct entity. Deep penetrating nevus is a distinct form of melanocytic nevus and may mimic various pigmented lesions. In addition, the possibility of the lesion being a melanoma variant or epidermotropic metastasis should be considered. The deep penetrating nevus may be considered a unique form of blue nevus, but some would include this lesion in the category of spitz nevus. State of the art, nomenclature, and points of consensus and. It can have a striking clinical presentation that mimics melanoma.
The most common precursor lesion is the cellular blue nevus cbn, but malignant transformation has been reported infrequently in common blue nevi cobn and otas nevi 10,11,16. Epidermal nevi are typically seen at birth or develop in early childhood. Department of clinical histopathology and neuropathology service, institute of pathology, university of berne, berne, switzerland. Both melanocytes and nevus cells can produce the pigment melanin. Regions that resemble a blue nevus looking for more information, highresolution images, or differential diagnoses on this entity. Although epithelioid blue nevus ebn is a rare variant of blue nevus that was first reported in patients with carney complex, which encompasses cardiac and cutaneous myxomas, spotty skin. Heavily pigmented, solitary, nevus with blue nevus features dermatol online j 2008. The blue colour is caused by the pigment being deeper in the skin than in ordinary nevi. Malignant tumours may arise within a nevus sebaceous. The expanding spectrum of cutaneous blue naevi current. The term melanocytic nevus comprises a wide range of benign melanocytic proliferations that differ with respect to their epidemiology, morphology, genetics and associated melanoma risk. It was a bluegray papule approximately 4 mm in diameter with a 4year history.
Blue nevus is a tumor of dermal dendritic melanocytic origin, and common blue nevus and cellular blue nevus are the most common variants. Histopathology skincompound clarks nevus dysplastic nevus. A hypomelanotic blue nevus, an uncommon variant, generally presents clinically as a depigmented papule with focal residual bluebrown pigment. Histopathology a compound nevus possesses features of both a junctional and an intradermal nevus. A number of pigmented lesions are difficult to classify and raise the possibility of a melanoma diagnosis. Acquired bilateral nevus of otalike macules horis nevus.
Sep 14, 2017 moles, also called nevi, can appear on your skin in a variety of shapes, sizes, and colors. Acquired nevus of otalike macules abnom, or horis nevus, clinically presents as bilateral, bluegray to graybrown macules of the zygomatic area. Apr 12, 2006 the most common location of the intraoral blue nevus is the hard palate. These nevi tend to occur mostly on the skin,predominantly on the head and neck, dorsal aspectsof the distal extremities, and the sacral area, butcan also occasionally appear on mucosal surfaces. A clinicopathologic study in recent years, several histopathologic variants of blue nevus have. In the blue nevus the pigmentproducing cells are spindled and fusiform dendritic cells rather than rounded or epithelioid. This lesion has distinct microscopic features which helps in excluding melanoma and establishing the correct diagnosis. Association of nevus sebaceus with an unusual type of combined nevus the histologic spectrum of pigmented spindle cell nevus. Agminated heterogeneous papules on the neck mdedge. Histopathological spectrum of benign melanocytic nevi our.
Soepronos textbook is available on and includes detailed information on over 600 entities and includes four dvd diskettes with highresolution images that provide a virtual dermatopathology. Blue nevus also known as blue neuronevus, dermal melanocytoma, nevus coeruleus and nevus bleu is a type of melanocytic nevus. Blue naevus nevus in american spelling is a type of melanocytic naevus in which spindleshaped or, less commonly, ovoid naevus cells, are located deep within the dermis. The blue nevus and variants represent a congenital or acquired, dermal collection of pigment producing melanocytes. Histopathology skin, kidney systemic sclerosis scleroderm duration. Intramucosal nevi make up more than one half of all reported intraoral melanocytic nevi. Blue nevi, pigmented epithelioid melanocytomas and dermal melanocytoses. Pdf nevus is a congenital pigmented malformation rarely found in the oral mucosa. Oculodermal melancytosis, the nevus of ota histopathology. Cellular blue nevus can also increase in size over time, where as common blue nevus are typically stable in size.
Malignant blue nevus is a rare melanocytic tumor that is described by some authors as a variant of malignant melanoma, whereas others regard it as a distinct entity. The blue nevus in benign pigmented lesion that presents as a dark blue domeshaped papule or as a flat macule on the skin or mucosa. Blue naevi and dermal melanocytoses are thought to result from the dermal arrest of precursor cells migrating from the neural crest in a similar manner to congenital naevi. A blue naevus is a small blue or greycoloured lesion of the skin, with an appearance similar to a mole. Benign melanocytic tumors malignant melanoma superficial spreading melanoma nodular melanoma lentigo maligna acral lentiginous melanoma desmoplastic melanoma melanoma arising from blue nevus melanoma arising in giant congenital nevus melanoma of childhood nevoid melanoma persistent melanoma. The causative cells are dendritic melanocytes, which are. Blue melanocytic naevi constitute a varied group of neoplasms, and some variants pose a considerable diagnostic challenge. A better recognition of the many dermoscopic faces of blue nevi is. Histopathology shows a proliferation of bland spindle cells within the dermis with associated sclerosis and without associated pigment. Blue nevus is a benign melanocytic lesion whose most frequent variants are dendritic common blue nevus and cellular blue nevus.
Dec 31, 2014 although epithelioid blue nevus ebn is a rare variant of blue nevus that was first reported in patients with carney complex, which encompasses cardiac and cutaneous myxomas, spotty skin pigmentation, endocrine overactivity, and psammomatous melanotic schwannomas, it has been also documented in the absence of such clinical features. Only three cases were of the compound type and only two were of the junctional type. Blue naevus was first described by tiesche in 1906. Soeprono teaches and practices dermatopathology at loma linda university, school of medicine, department of dermatology. Causes of erroneous diagnosis of malignancy include large size, involvement of deep tissues, asymmetrical pigmentation, apparent satellitosis and presence of lymph node deposits. In principle they are harmless but they can sometimes be mimicked by malignant lesions, i. Challenging areas in diagnosis of blue nevi include recognition of amelanotic, desmoplastic, atypical, and malignant variants of blue nevus. Jul 31, 20 regions that resemble a blue nevus looking for more information, highresolution images, or differential diagnoses on this entity. The melaninproducing cells of a blue nevus differ from those of the nevi previously discussed. Nevus cells in the upper, middle, and lower dermis may present.
Dermal melanocytoses and variants diagnostic histopathology. To our knowledge no molecular studies of this tumor have been performed, although the molecular pathogenesis of conventional melanomas has been extensively described. Blue nevi are classically highly pigmented benign lesions with a bluish coloration, arising from dermal dendritic melanocytes. Blue nevus and its distinction from mongolian spot and the. Pathology of deep penetrating nevus a benign pigmented tumour which should. There are several types of epidermal nevus that are defined in part by the type of epidermal cell. Dendritic cells cannot be appreciated without melanin pigmentation. Malignant blue nevus mbn is a rare neoplasm, first described by allen and spitz in 1953.
Our dermatology online brief report hhistopathological. Melanocytic proliferations are composed of one or more of three related types of cells. Pathology of deep penetrating nevus dr sampurna roy md. The six lesions were from three men and three women whose ages ranged from 11 to 51 years mean, 31 years. Nevus of ota nevus fuscoceruleus ophthalmomaxillaris is a blue gray or brown irregular, often spotted skin discoloration located on the face in the distribution of the first and second branches of the trigeminal nerve i. Jul 31, 20 dermatopathology reference describes common blue nevus histopathology including histologic features and provides links to additional medical references. Blue naevi are benign lesions often appearing in childhood or adolescence. Ebn is another variant of blue nevus that arises in the background of carney complex or may occur sporadically.
Blue nevi are benign proliferations of melaninproducingdendritic melanocytes located in thedermis. Melanocytic nevi are benign neoplasms or hamartomas composed of melanocytes, the pigmentproducing cells that constitutively colonize the epidermis. Diamantis department of clinical histopathology and neuropathology service, institute of pathology, university of berne, berne, switzerland. A case of epithelioid blue nevus pubmed central pmc. A blue nevus can be diagnosed by visual inspection alone, but a biopsy is required to find out if a cellular blue. Acquired nevi can be classified as common banal or atypical, and there are several additional variants, including halo nevi, blue nevi, and spitz nevi. Ancient blue nevi show stromal changes of large dilated vessels with pseudoangiomatous features, hyaline angiopathy, myxoid changes, sclerosis or hyalinization of stroma and variable edema, similar to ancient melanocytic nevi am j dermatopathol 2008. In blue nevus pigmentproducing cells are spindled and fusiform dendritic cells.
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