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Colebatch AJ, Adhikari C, Diefenbach RJ, Rawson RV, Ferguson PM, Rizos H, Long GV, McCarthy SW, Thompson JF, Wilmott JS, Scolyer RA. Comprehensive Clinical, Histopathologic, and Molecular Analysis and Long-term Follow-up of Patients With Nodal Blue Nevi. Am J Surg Pathol 2022; 46:1048-1059. [PMID: 35439782 DOI: 10.1097/pas.0000000000001902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Blue nevi are benign, melanocytic neoplasms that show a range of clinical and morphologic patterns and include common/dendritic, cellular, and atypical cellular subtypes. Like other nevi, they most commonly occur in skin but can occasionally involve lymph nodes where they may be misinterpreted as representing metastatic melanoma. Moreover, whether benign blue nevi can metastasize to lymph nodes and their natural history and prognostic significance has been the subject of great controversy. To date, few cases of nodal blue nevi have been reported in the literature, and those reports have had limited clinical follow-up and supporting molecular data. This study sought to determine the clinical, pathologic, and molecular features of blue nevi involving lymph nodes, clarify their clinical significance, provide evidence for understanding their pathogenesis, and highlight potential pitfalls in the interpretation of lymph nodes with an ultimate aim of improving patient care. Thirteen cases of blue nevi involving lymph nodes were identified in the archives of Royal Prince Alfred Hospital, Sydney, Australia (1984-2018). A detailed assessment of the clinical and pathologic features of each case was performed, including an evaluation of all available immunohistochemical stains. Extended clinical follow-up was available for 9 patients. Droplet digital polymerase chain reaction for GNAQ Q209L, Q209P and GNA11 Q209L mutations was performed on 7 cases of blue nevi within lymph nodes together with matching cutaneous (presumed primary) blue nevi in 2 cases. All cases showed typical histologic features of blue nevi. BAP1 was retained in all cases (n=7). There were no recurrence or metastasis of blue nevus in any case on long-term clinical follow-up (n=9, median follow-up, 12 y). The majority of cases (n=5 of 7 evaluated) had GNAQ and GNA11 driver mutations. The 2 patients with a matched primary cutaneous blue nevus and regionally associated nodal blue nevus had the same GNAQ Q209L mutation in both sites in each patient. We conclude that blue nevi can involve lymph nodes and are associated with benign clinical behavior, and probably represent so-called "benign" metastasis. Awareness of these lesions is important when evaluating lymph nodes to avoid misdiagnosis as metastatic melanoma.
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Affiliation(s)
- Andrew J Colebatch
- Melanoma Institute Australia
- Faculty of Medicine and Health
- NSW Health Pathology
- Royal Prince Alfred Hospital
| | - Chandra Adhikari
- Melanoma Institute Australia
- Faculty of Medicine and Health
- NSW Health Pathology
| | - Russell J Diefenbach
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Robert V Rawson
- Melanoma Institute Australia
- Faculty of Medicine and Health
- NSW Health Pathology
- Royal Prince Alfred Hospital
| | - Peter M Ferguson
- Melanoma Institute Australia
- Faculty of Medicine and Health
- NSW Health Pathology
- Royal Prince Alfred Hospital
| | - Helen Rizos
- Melanoma Institute Australia
- Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Georgina V Long
- Melanoma Institute Australia
- Faculty of Medicine and Health
- Charles Perkins Centre, The University of Sydney
- Royal North Shore and Mater Hospitals
| | - Stanley W McCarthy
- Melanoma Institute Australia
- Faculty of Medicine and Health
- NSW Health Pathology
- Royal Prince Alfred Hospital
| | - John F Thompson
- Melanoma Institute Australia
- Faculty of Medicine and Health
- Royal Prince Alfred Hospital
| | - James S Wilmott
- Melanoma Institute Australia
- Faculty of Medicine and Health
- Charles Perkins Centre, The University of Sydney
| | - Richard A Scolyer
- Melanoma Institute Australia
- Faculty of Medicine and Health
- Charles Perkins Centre, The University of Sydney
- NSW Health Pathology
- Royal Prince Alfred Hospital
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Blue Nevus of the Hard Palate: The Importance of a Careful Examination in an Emergency Setting. Case Rep Dermatol Med 2022; 2022:6329334. [PMID: 35211347 PMCID: PMC8863491 DOI: 10.1155/2022/6329334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/28/2022] [Indexed: 12/02/2022] Open
Abstract
Oral common blue nevus is an asymptomatic, benign, rare, pigmented lesion and sometimes clinically indistinguishable from other pigmented lesions such as the cellular blue nevus or early-stage malignant melanoma. Since it shows clinical similarities with a malignant lesion and with cellular blue nevus that can itself suffer malignant transformation, the decisive diagnosis is crucial for adequate treatment, follow-up, and prognosis. Diagnosis confirmation is given by histological analysis, the reason why most oral pigmented lesions are excised. The following case presents an asymptomatic oral pigmented lesion of the hard palate discovered during observation in an emergency setting due to an abscess of dental origin. The lesion was fully excised, and histological examination reported a “common blue nevus.” In this case, we intend to present a rare lesion of the oral cavity and the importance of performing a routine oral examination when given a chance as a preventive approach.
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Boven L, Noonan M, Sans-Cuellar H, Dela-Cruz N, Nathan C, Gungor A. Cellular blue nevus tumor presenting as a submandibular lymph node in a 16-year-old. Am J Otolaryngol 2021; 42:103139. [PMID: 34174671 DOI: 10.1016/j.amjoto.2021.103139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/13/2021] [Indexed: 11/18/2022]
Abstract
The cellular blue nevus tumor is a type of dendritic melanocytic nevus that is typically benign and exceedingly rare. The incidence of all blue nevi is about 1%, usually affecting the adult population and appearing on the extremities, sacrococcygeal or gluteal regions. There have only been a handful of case reports cited in the literature where cellular blue nevi present in the head and neck region, usually affecting the scalp and young adult population (7, 8). As such, it is exceedingly rare to encounter a cellular blue nevus tumor in the neck or infiltrating into neck lymph nodes. Here we report a rare case of a cellular blue nevus tumor presenting as a right neck mass in a pediatric 16-year-old patient, shown to invade into the submandibular lymph node and surrounding soft tissue. It is important to be aware of the cellular blue nevus tumor as a differential diagnosis in pediatric neck masses. Histological evaluation is necessary to determine tumor aggression and malignant potential which can guide further treatment in pediatric patients.
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Affiliation(s)
- L Boven
- Department of Otolaryngology-H&N Surgery, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA.
| | - M Noonan
- Department of Otolaryngology-H&N Surgery, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA
| | - H Sans-Cuellar
- Department of Radiology, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA
| | - N Dela-Cruz
- Department of Pathology, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA
| | - C Nathan
- Department of Otolaryngology-H&N Surgery, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA
| | - A Gungor
- Department of Otolaryngology-H&N Surgery, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA
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Cullom ME, Fraga GR, Reeves AR, Bhavsar D, Andrews BT. Giant Congenital Blue Nevus Presenting as Cutis Verticis Gyrata: A Case Report and Review of the Literature. Ann Otol Rhinol Laryngol 2021; 130:1407-1411. [PMID: 33813872 DOI: 10.1177/00034894211007236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Cerebriform intradermal nevus and giant congenital blue nevi are rarely reported melanocytic nevi with clinical and histopathologic similarities. Both are known to produce cutis verticis gyrata. We report a significantly large occipital scalp congenital blue nevus with secondary cutis verticis gyrata. The aim of this report is to increase clinical awareness of this entity, highlight histopathologic and mutational features of cerebriform intradermal nevi and giant congenital blue nevi, and stress the importance of clinicopathologic correlation for diagnosis. METHODS Case report and review of the literature. RESULTS A 20-year-old Asian male presented with a long-standing, large (20 cm × 30 cm), exophytic tumor at the occipital scalp and posterior neck. The skin overlying the lesion was arranged in thick folds resembling the surface of the brain, devoid of hair follicles, and discolored by salt-and-pepper pattern hyperpigmentation. After correlating the clinical and histopathologic findings, we diagnosed giant congenital blue nevus with secondary cutis verticis gyrata. Staged surgical excision was performed with subsequent treatment for hypertrophic scarring and occipital alopecia. CONCLUSIONS Cerebriform intradermal nevus and giant congenital blue nevus have overlapping histologic and clinical features. Head and neck surgeons should be aware that nomenclature of these tumors is subjective and often imprecise. Diagnosis requires correlation of clinical findings, patient history, and histopathology. Surgical excision is advised due to rare malignant transformation potential.
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Affiliation(s)
| | - Garth R Fraga
- Department of Pathology, University of Kansas, Kansas City, KS, USA
| | - Alan R Reeves
- Department of Radiology, University of Kansas, Kansas City, KS, USA
| | - Dhaval Bhavsar
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Brian T Andrews
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
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Temelkova I, Stavrov K, Yungareva I, Wollina U, Mangarov H, Radinoff A, Popova TN, Tchernev G. Nevus Blue as a Sporadic Finding in a Patient with a Blue Toe? Open Access Maced J Med Sci 2018; 6:855-858. [PMID: 29875860 PMCID: PMC5985889 DOI: 10.3889/oamjms.2018.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 05/05/2018] [Accepted: 05/06/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: Blue nevus is an interesting finding, which aetiology and risk of locoregional and distant metastasis have not yet been fully clarified. It may be inherited or acquired, with sporadic cases usually presented as solitary lesions. It is often localised in the area of the head and less often on the arms, legs or trunk. Blue nevi are formations with relatively low but still possible potential for switching to melanoma. CASE REPORT: The patient we described was hospitalised for pronounced cyanosis of the small toe of the right foot, accompanied by painful symptoms at rest and pain symptoms for a few weeks. Using inpatient paraclinical and instrumental tests, the patient was diagnosed with cholesterol microembolism. During the dermatological examination, blue nevus on the contralaterally localised limb was also diagnosed as a sporadic finding. According to the patient’s medical history, the finding had existed for many years, but in the last few months, the patient has observed growth and progression in the peripheral zone of the nevus without any additional clinical symptoms. CONCLUSION: Due to the risk of progression to melanoma, the lesion was removed by radical excision, and the defect was closed by tissue advancement flap.
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Affiliation(s)
- Ivanka Temelkova
- Medical Institute of the Ministry of Interior (MVR-Sofia), Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - Konstantin Stavrov
- Medical Institute of the Ministry of Interior (MVR-Sofia), Dermatology and Dermatosurgery, Sofia, Bulgaria
| | - Irina Yungareva
- Medical Institute of the Ministry of Interior (MVR-Sofia), Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - Uwe Wollina
- Städtisches Klinikum Dresden, Department of Dermatology and Allergology, Dresden, Germany
| | - Hristo Mangarov
- Medical Institute of the Ministry of Interior (MVR-Sofia), Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - Atanas Radinoff
- Department of Clinical Hematology, University Multiprofile Hospital for Active Treatment "Sveti Ivan Rilski", 15, Acad. Ivan Geshov Blvd., Sofia 431, Bulgaria
| | - Tanya Naskova Popova
- Department of Clinical Hematology, University Multiprofile Hospital for Active Treatment "Sveti Ivan Rilski", 15, Acad. Ivan Geshov Blvd., Sofia 431, Bulgaria
| | - Georgi Tchernev
- Medical Institute of the Ministry of Interior (MVR-Sofia), Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria.,Onkoderma - Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
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Rao AG, Koppada D, Haritha M. Giant Cerebriform Congenital Cellular Blue Nevus Presenting as Cutis Verticis Gyrata. Indian J Dermatol 2016; 61:126. [PMID: 26955158 PMCID: PMC4763674 DOI: 10.4103/0019-5154.174164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Divya Koppada
- Department of Dermatology, SVS Medical College, Yenugonda, Telangana, India. E-mail:
| | - M Haritha
- Department of Dermatology, SVS Medical College, Yenugonda, Telangana, India. E-mail:
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Gambichler T, Scholl L, Stücker M, Bechara FG, Hoffmann K, Altmeyer P, Othlinghaus N. Clinical characteristics and survival data of melanoma patients with nevus cell aggregates within sentinel lymph nodes. Am J Clin Pathol 2013; 139:566-73. [PMID: 23596107 DOI: 10.1309/ajcpg83cmavfbwlc] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Histopathologic differentiation of nevus cell aggregates and metastatic melanoma in lymph nodes is challenging. Patients with melanoma who had undergone sentinel lymph node (SLN) biopsy were evaluated using univariate and multivariate analyses as well as Kaplan-Meier statistics. Of the 651 patients, 50 (7.7%) had a nodal nevus in the SLN. In the logistic regression model, primary melanoma on the lower extremities proved to be the strongest independent negative predictor of nodal nevi with an odds ratio of 0.11 (95% confidence interval, 0.034-0.36; P = .0002). Overall 5-year survival (P = .17) and 5-year disease-free survival (P = .45) of patients with nodal nevi did not significantly differ from that of patients with negative SLNs. The frequency and anatomic localization of nodal nevi observed in the present study are in line with previous studies. Our 5-year survival data clearly demonstrate that nevus cell aggregates in lymph nodes have to be considered a benign condition even though it occurs in patients with melanoma. This study provides an indirect proof of validity and accuracy of current histopathologic methods for differentiation between nodal nevi and melanoma metastasis.
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Affiliation(s)
- Thilo Gambichler
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Lisa Scholl
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Markus Stücker
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Falk G. Bechara
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Klaus Hoffmann
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Peter Altmeyer
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Nick Othlinghaus
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center Ruhr-University, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
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Amelanotic cellular blue nevus: an unusual iris localization. Case Rep Ophthalmol Med 2012; 2012:209603. [PMID: 23008791 PMCID: PMC3431064 DOI: 10.1155/2012/209603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 07/19/2012] [Indexed: 11/18/2022] Open
Abstract
The authors describe the first case of eye amelanotic cellular blue nevus reported in literature and discuss the main differential diagnosis.
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Furtado SV, Ghosal N, Hegde AS. Calvarial malignant melanotic neuroectodermal tumour of infancy presenting with widespread intracranial metastasis. J Craniomaxillofac Surg 2012; 40:e170-3. [DOI: 10.1016/j.jcms.2011.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 08/22/2011] [Accepted: 08/24/2011] [Indexed: 10/17/2022] Open
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Cellular blue nevus of the vulva mimicking Bartholin’s gland abscess in a 15-year-old girl: a case report. Arch Gynecol Obstet 2011; 285:1009-11. [DOI: 10.1007/s00404-011-2088-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 09/06/2011] [Indexed: 10/17/2022]
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