Intramucosal nevi make up more than one half of all reported intraoral melanocytic nevi. Lesions of blue nevus can be differentiated by their characteristic dendritic melanocytes and absence of junctional activity. 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. Atypical cellular blue nevi cellular blue nevi with.
Very few cases of common blue nevus with satellites have been reported so far. Combined cellular blue nevus and trichoepithelioma. Both are most commonly observed in the head and neck region, on hand, feet and in the lumber area. Due to this factor, the nevus is typically removed through a surgery.
The tumor may reach deep into the dermis or subcutaneous fat. What are the possible complications of cellular blue nevus. An atypical cellular blue nevus without copy number aberrations case 6. Cellular blue nevus, journal of cutaneous pathology 10. Blue nevi are classically highly pigmented benign lesions with a bluish coloration, arising from dermal dendritic melanocytes. Histologically, the common blue nevus is composed of elongated, sometimes finely branching melanocytes in the interstices of dermal collagen in upper and middermis. Later, it was classified as a variant of blue nevus. Common blue nevus and cellular blue nevus differ in appearance, although both types of blue nevi are of slate blue or dark blue color 8.
Cogan laboratory of ophthalmic pathology at the massachusetts eye and ear infirmary, we retrieved conjunctival lesions that had been diagnosed as atypical nevus, nevus with unusual features, borderline nevus, balloon cell nevus, or blue nevus. Thus it can be wrongly diagnosed as melanoma due to atypia criteria that may be present 36. There are no general rules of universal applicability in differentiating benign from malignant lesions. Here, we report on the diagnosis of various cellular blue melanocytic neoplasms by 14 dermatopathologists who routinely examine melanocytic lesions. Many histologic subtypes exist and there may be extensive variability in the extent of sclerosis, cellular architecture, and tissue cellularity between each variant. The probability of a cellular blue nevus transforming into a malignant melanoma is greater than melanoma arising from a common blue nevus. Pathologists are able to determine the diagnosis and the type of blue nevus during histology evaluation.
Dd nodular melanoma metastatic melanoma giant cellular blue nevus with subcutaneous cellular nodules 8. Controversy still arises over the precise distinction of atypical cellular blue nevus from melanoma. Updates on molecular diagnostic assays in melanocytic. Malignant melanoma has been reported to arise with the cellular blue nevi. Histology of combined trichoepithelioma and cellular blue naevus. The cellular blue nevus is a less common lesion but often clinically similar to the common blue nevus. Cellular blue nevus diagnosed following excision of melanoma. The malignant blue nevus is a variant of melanoma, distinguished from cellular blue nevus by invasiveness, cellular atypia, pleomorphism, atypical mitoses, and areas of necrosis. Congenital giant cellular blue nevus resulting in dystocia. From the regular and consultation files of the david g. The majority of moles appear during the first two decades of a persons life, with about one in every 100. Combined cellular blue naevus and trichoepithelioma.
The patients were caucasian 6 females and 3 males with a mean and median age of 4751 years. Melanocytes may have atypical nuclei and mitoses are sometimes present. Dermal melanocytoses and variants diagnostic histopathology. Lesions, which are predominantly cellular blue naevi, can mimic both primary and secondary melanoma. Updates on molecular diagnostic assays in melanocytic pathology. The distinction of cellular blue nevi cbn with atypical features atypical cbn acbn from conventional cbn and malignant melanomas related to or derived from cbn remains a difficult problem. Key words cellular blue nevus, buttock, malignant m introduction blue nevi are usually seen on skin and rarely on.
Epithelioid cells are admixed with dendritic cells and resemble clear cells of cellular blue nevus hematoxylineosin, original magnifications 320 a, c, and e and 3400 b, d, and f. Proposed by mihm et al, the lesion demonstrates clinicopathological features intermediate between cellular blue nevus and malignant blue nevus. Cellular blue nevus can be clinically and histogenetically confused with malignant melanoma but remains a benign neoplasm of uncertain histogenesis. Moles, also called nevi, can appear on your skin in a variety of shapes, sizes, and colors. Mast cell numbers in melanocytic naevi and cutaneous neurofibromas article pdf available in journal of clinical pathology 461. They can cause diagnostic difficulty if they are of a large size, and extend into fat. In blue nevus pigmentproducing cells are spindled and fusiform dendritic cells. A 32yearold woman presented with an asymptomatic, 10mm, bluish papular lesion on her scalp that had been noticed since childhood and that recently enlarged. At high magnification, cellular blue nevus areas show uniform oval cells with inconspicuous nucleoli and clear cytoplasm. State of the art, nomenclature, and points of consensus. May 14, 2018 the cellular blue nevus was first described as a variant of melanoma. They are usually present as solitary lesions and do not provoke any symptoms aside from aesthetic problems.
Aug 30, 2018 the blue nevus is composed of pigmented dermal melanocytes and is represented by two histologic types. The blue nevus and variants represent a congenital or acquired, dermal collection of pigment producing melanocytes. For the blue nevus like group the diagnostically challenging categories are cellular blue nevus cbn, atypical cbn and melanoma arising inresembling cbn. It can have a striking clinical presentation that mimics melanoma. These two variants can sometimes be differentiated on clinical appearance. The common blue nevus is the second most common variant. Immunohistochemical studies of atypical conjunctival. Here we report 3 cases of cellular blue nevi in the lower eyelid, and make recommendations about approaching these challenging lesions. Pdf atypical cellular blue nevus or malignant blue nevus. 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.
May 26, 2016 cellular blue nevus cbn differs from classic blue nevus since it exhibits a cellular appearance and presents itself with subcutaneous infiltration, intensive pigmentation, and a large size. Combined trichoepithelioma and cellular blue naevus is a rare. A number of pigmented lesions are difficult to classify and raise the possibility of a melanoma diagnosis. Among the 3 variants of blue nevi, the cellular variant occurs less frequently than the common and combined variants. Cellular blue nevus with atypia atypical cellular blue nevus.
There is evidence of architectural and cytological atypia together with necrosis. Cellular lobular mass, or sometimes multiple lobules, centered on the reticular dermis and sometimes extending into the subcutaneous fat. A melanocytic nevus also known as nevocytic nevus, nevus cell nevus and commonly as a mole is a type of melanocytic tumor that contains nevus cells. The oral spitz nevus has the same histopathology as its cutaneous counterpart, with the general appearance of a compound nevus with zonal differentiation from the superficial to deep portions of the nodule. The histology was consistent with cellular blue nevus cbn. A blue nevus may be found in conjunction with an overlying melanocytic nevus, in which case the term combined nevus is used. Nevus or nevi if multiple is a nonspecific medical term for a visible, circumscribed, chronic lesion of the skin or mucosa.
Lamb syndrome is the association of blue nevi with lentigines and skin papules and underlying atrial cardiac myxomas. Naevi from the auricular region, breast, conjunctiva and ankle sometimes have a rather atypical proliferation of melanocytes in the epidermis, often with pagetosis and cytological atypia. Melanocytic lesions are commonly encountered in dermatopathology and an area which causes some difficulty, i. In principle they are harmless but they can sometimes be mimicked by malignant lesions, i. Nov 17, 2018 a malignant melanoma arising from a blue nevus is very uncommon and is mostly observed in adults. The blue colour is caused by the pigment being deeper in the skin than in ordinary nevi. The lesion is composed of blue nevus with small cellular nodules of epithelioid cells. The distinction of a cellular blue nevus with atypical features from melanoma can be difficult. Presents as a wellcircumscribed 1 to 2cm blue to black area of discoloration, most commonly on the buttocks, sacral area or scalp.
The histologically because malignant melanoma or malignant transformation of a blue nevus could be considered. Some sources equate the term mole with melanocytic nevus, but there are also sources that equate the term mole with any nevus form. Concentrated data collection and followup, molecular characterization, and future consensus. Blue nevus is a benign melanocytic lesion whose most frequent variants are dendritic common blue nevus and cellular blue nevus. Cellular blue nevus can also increase in size over time, where as common blue nevus are typically stable in size. Genomic copy number analysis of a spectrum of blue nevi. May 22, 2007 histopathology skin cellular blue nevus. Proliferating cell nuclear antigen staining in deeppenetrating nevi deep penetrating nevus.
Blue naevi have traditionally been divided into common and cellular blue types but the separation is artificial because there is frequent overlap. Cellular blue naevus is generally much larger than a common blue naevus and usually involves the entire dermis. Our dermatology online brief report hhistopathological. There are frequently no complications that arise from a cellular blue nevus. Cellular blue nevus, which is a benign variant with a component of common blue nevus, as well as distinct cellular areas composed of spindled to oval melanocytes, have been described in the cervix. An 8yearold child presented a pigmented lesion in the buttock since birth, but with. Cellular blue nevus, however, are typically larger in size at least 1 cm in diameter, and more nodular. Oculodermal melancytosis, the nevus of ota histopathology. Most blue nevi occur on the skin, especially in the head and neck region, sacral region, and dorsal aspects of the distal extremities. However, in rare cases, a cellular blue nevus can transform into a melanoma a malignant skin cancer. Blue nevus as in the common dendritic type, in addition with areas composed of roundish, nondendritic melanocytes with broad cytoplasm and low melanin production.
Blue nevus also known as blue neuronevus, dermal melanocytoma, nevus coeruleus and nevus bleu is a type of melanocytic nevus. Blue nevus cell carcinoma derick mussen healthcare. Localized argyria with pseudoochronosis mdedge dermatology. Benign melanocytic naevi in various sites may show unusual histopathological features that may mimic melanoma. Atypical cellular blue nevi cellular blue nevi with atypica. In addition, there is always the possibility that what is seen clinically is a malignant melanoma and not a blue nevus. Cellular blue nevus cbn differs from classic blue nevus since it exhibits a cellular appearance and presents itself with subcutaneous infiltration, intensive pigmentation, and a large size. This paper reports the ultrastructural features of three cases of cellular blue nevus and emphasizes melanosomal alterations, including immature and granular forms, multiple layers of basement membrane around vessels, nerve fibers and tumor cells. Combined cellular blue nevus and trichoepithelioma europe. In addition, the possibility of the lesion being a melanoma variant or epidermotropic metastasis should be considered. The blue nevus is found most frequently on the skin. Atypical cellular blue nevus acbn has clinicopathologic features intermediate between typical cellular blue nevus cbn and the rare malignant blue nevus mbnmalignant melanoma mm arising in a cbn.
Special tests imaging tests of the heart may be required if there is concern for carney complexmyxoma syndromelamb. Usually pigmented, biphasic tumor with component of classic blue nevus and distinct cellular areas composed of spindled to oval melanocytes with clear or finelypigmented cytoplasm arch pathol lab med 2011. Cellular blue nevus with atypia atypical cellular blue. Combined cellular blue nevus and trichoepithelioma is a rarely reported but distinctive biphasic tumor. According to the original description by tieche 33, to which little can be added, blue nevus is a dermalbased, benign melanocytic lesion histopathologically made up by variable proportions of ovalspindle and bipolar, usually heavily pigmented dendritic cells g. A blue nevus is a collection of proliferating dermal melanocytes. Pdf combined cellular blue nevus and trichoepithelioma. In combined trichoepithelioma and cellular blue naevus, the histopathology shows a fairly wellcircumscribed biphasic dermal proliferation involving the full thickness of the dermis and shows tongues of rounded tumour fronts figure 1. Part 1 of my in progress video series about the pathology of melanocytic skin lesions. Feb 24, 2020 what are the possible complications of cellular blue nevus. Cellular blue nevus diagnosed following excision of. The architecture is a rather distinctive mass composed of a lobular tongue or tongues into deep dermis figure 6.
Therefore, our case of intraoral cellular blue nevus is the first report of this entity in the oral mucosa. No atypical mitoses were present and there was no evidence of metastasis. A blue nevus can be diagnosed by visual inspection alone, but a biopsy is required to find out if a cellular blue. Laterally the lesion merges with the dermis without a clear margin and macrophages containing melanin are often found 2,4. Dermal melanocytoses form a spectrum of benign intradermal melanocytic lesions composed of dendritic melanocytes, the most common of which is the blue naevus. Pdf mast cell numbers in melanocytic naevi and cutaneous. A hypomelanotic blue nevus, an uncommon variant, generally presents clinically as a depigmented papule with focal residual blue brown pigment.
C and d, large cellular blue nevus showing dumbbellshaped configuration. Blue nevus is a benign pigmented lesion of dermal melanocytes with a number of histologic and clinical variants, of which the major types are the common blue nevus, cellular blue nevus and. Atypical cellular blue nevus presents an intermediate histopathology between the typical and a rare variant of malignant blue nevus melanoma arising in a cellular blue nevus. Care should be exercised to exclude nonmelanocytic lesions, and benign melanocytic entities, both of which can mimic melanoma histologically. In each case, a diagnosis of cellular blue nevus was made using the following features. Cellular blue nevus cbn is a variant of blue nevus, characterized by marked cellularity and a biphasic pattern of melaninladen dendritic cells and larger cells containing little or no melanin.
This video discusses the basic features and patterns that are common. Bimodal age presentation most commonly on trunk presents as a firm nodule or dark brown to black discoloured area in the midst of the naevus can also present as a cyst 10. Apr 12, 2006 the most common location of the intraoral blue nevus is the hard palate. The other microscopic differential diagnoses of dpn include blue nevus, cellular blue nevus, spindle and epithelioid cell nevus, and congenital melanocytic nevus. Pdf biphasic lesions composed of melanocytic and epithelial components are not uncommon.
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