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A 31-year-old woman is referred for evaluation of a mole on her left upper arm. She states that the lesion has been present for several years. The lesion has never bled but has grown in size over the past several months. She is fair skinned and admits to frequent sunburns since early childhood but has never used an indoor tanning bed and has no history of prior skin cancer. The physical examination reveals a 1.4cm pigmented lesion with a slightly elevated, darkened center.
Blue nevi are benign proliferations of fusiform dermal melanocytes containing abundant melanin granules in the submucosa or deep dermis. These lesions are believed to arise from arrested migration within the dermis during embryonic development and may become apparent at any...
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Blue nevi are benign proliferations of fusiform dermal melanocytes containing abundant melanin granules in the submucosa or deep dermis. These lesions are believed to arise from arrested migration within the dermis during embryonic development and may become apparent at any age.1
The most common presentation is a blue-black-brown macule or papule with a diameter less than 0.5 cm in diameter. On dermoscopy, lesions typically manifest a steel-blue homogeneous pattern; local features include whitish scar-like depigmentation, dots/globules, peripheral streaks or vessels.2
Although clinical diagnosis of a common blue nevus is relatively straightforward, the presence of any irregular edges or satellite macules may suggest malignancy or recurrence if previously removed.3
The histology of blue nevi may vary but usually reveals a vertical wedge or bulbous shaped proliferation of spindle cells, dendritic melanocytes, and melanophages accompanied by a sclerotic dermis.4,5 Variants include cellular, combined, deep penetrating, and epitheloid forms.4,5 The gold standard for definitive diagnosis is histologic examination and, if atypia or melanoma are suspected, excisional biopsy is recommended.5 Findings indicative of atypia or malignancy include increased mitotic rate, overcrowding, and invasion into vascular structures.4,5
Sidney Lampert is a medical student at the Drexel University College of Medicine, in Philadelphia. Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College.
References
- Murali R, McCarthy SW, Scolyer RA. Blue nevi and related lesions: a review highlighting atypical and newly described variants, distinguishing features and diagnostic pitfalls. Adv Anat Pathol. 2009;16(6):365-382. doi:10.1097/PAP.0b013e3181bb6b53
- Di Cesare A, Sera F, Gulia A, et al. The spectrum of dermatoscopic patterns in blue nevi. J Am Acad Dermatol. 2012;67(2):199-205. doi:10.1016/j.jaad.2011.08.018
- Kneitz H, Rose C, Glutsch V, Goebeler M. Recurrence of a cellular blue nevus with satellitosis—a diagnostic pitfall with clinical consequences. Dermatopathology (Basel). 2022;9(4):361-367. doi:10.3390/dermatopathology9040042
- Zembowicz A, Phadke PA. Blue nevi and variants: an update. Arch Pathol Lab Med. 2011;135(3):327-336. doi:10.5858/2009-0733-RA.1
- Austad SS, Athalye L. Blue Nevus. In: StatPearls [Internet]. StatPearls Publishing; October 31, 2022.
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