eMedicine Specialties > Dermatology > Benign Neoplasms

Blue Nevi

Author: Rudolf R Roth, MD, Medical Director, Department of Dermatology, Penn Medicine at Radnor; Associate Professor of Clinical Dermatology, Department of Dermatology, University of Pennsylvania School of Medicine
Coauthor(s): Scott M Acker, MD, Associate Professor, Director of Dermatopathology, Departments of Dermatology and Pathology, University of Alabama at Birmingham
Contributor Information and Disclosures

Updated: Mar 10, 2009

Introduction

Background

Two clinically recognized variants of blue nevus exist: the common blue nevus and the cellular blue nevus.

Tièche, a student of Jadassohn, first described the common blue nevus in 1906. Earlier authors described similar lesions as chromatophoroma and melanofibroma. The common blue nevus is a flat to slightly elevated, smooth surfaced macule, papule, or plaque that is gray-blue to bluish black in color. Lesions are usually solitary and found on the head and the neck, the sacral region, and the dorsal aspects of the hands and feet.

The cellular blue nevus was first described as a variant of melanoma. Later, it was classified as a variant of blue nevus. Controversy still arises over the precise distinction of atypical cellular blue nevus from melanoma. The cellular blue nevus is a less common lesion but often clinically similar to the common blue nevus. These lesions tend to be large, usually measuring 1-3 cm in diameter. Lesions are elevated, smooth-surfaced papules or plaques that are gray-blue to bluish black in color. Lesions are usually solitary and found on the buttocks, the sacral region, and occasionally on the dorsal aspects of the hands and the feet.

Pathophysiology

Although definitive experimental evidence is lacking, blue nevi are believed to represent dermal arrest in embryonal migration of neural crest melanocytes that fail to reach the epidermis. Collections of melanocytes can be found in fetal dermis, but they involute during later gestation.

Because of the variation of blue nevi in different populations, a genetic predisposition has been suggested. However, familial cases of blue nevi are exceedingly rare.

The clinically noted blue color is due to the depth of melanin in the epidermis and the Tyndall effect. The Tyndall effect is the preferential absorption of long wavelengths of light by melanin and the scattering of shorter wavelengths, representing the blue end of the spectrum, by collagen bundles.

Common and cellular blue nevi are not associated with chromosomal aberrations,1 and they show fewer B-RAF mutations compared with congenital and acquired nevi.2

Frequency

United States

Blue nevi are most frequently noted in Asian populations, where the prevalence is estimated to be 3-5% in adults. They are found in 1-2% of white adults and are rarely found in blacks. Blue nevi are uncommon at birth or in the first few years of life, with an estimated prevalence of less than 1 case per 1000 population.

International

The international incidence of blue nevi varies with the population examined.

Mortality/Morbidity

  • Most cases remain entirely benign. Blue nevi usually persist unchanged throughout life and are asymptomatic.
  • Rare cases of malignant melanoma have been reported arising in association with cellular blue nevi.3

Sex

  • Blue nevi are twice as common in women than in men.

Age

  • Blue nevi may develop at any age but are usually noticed in the second decade of life or later.

Clinical

History

  • Once a blue nevus appears, it tends to remain unchanged throughout life. Occasionally, common blue nevi flatten and fade in color. These changes are evenly distributed throughout the lesion.
  • Malignant change in cellular blue nevi may be heralded by a sudden increase in size and occasionally ulceration.
  • Cases of eruptive blue nevi have been reported, some following skin trauma, such as sunburn.

Physical

  • Blue nevi are usually smooth-surfaced, dome-shaped papules that slowly develop from a macule to a papule.
  • Common blue nevi tend to be smaller than 1 cm, and cellular blue nevi tend to be larger than 1 cm.
  • Blue nevi are most commonly found on the skin. Rare cases of common blue nevi have been reported in the vagina, the spermatic cord, the uterine cervix, the lymph node, the prostate, the oral mucosa, and the bronchus.
Common blue nevus on the scalp.

Common blue nevus on the scalp.

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Common blue nevus on the scalp.

Common blue nevus on the scalp.




Common blue nevus on the hand.

Common blue nevus on the hand.

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Common blue nevus on the hand.

Common blue nevus on the hand.


Causes

  • See Pathophysiology. Although blue nevi are most frequently seen on the skin, they have also been reported in the oral cavity, subungually,4 in lymph nodes, and in organs such as the brain, pulmonary tract, and prostate.

More on Blue Nevi

Overview: Blue Nevi
Differential Diagnoses & Workup: Blue Nevi
Treatment & Medication: Blue Nevi
Follow-up: Blue Nevi
Multimedia: Blue Nevi
References
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References

  1. Maize JC Jr, McCalmont TH, Carlson JA, Busam KJ, Kutzner H, Bastian BC. Genomic analysis of blue nevi and related dermal melanocytic proliferations. Am J Surg Pathol. Sep 2005;29(9):1214-20. [Medline].

  2. Gill M, Celebi JT. B-RAF and melanocytic neoplasia. J Am Acad Dermatol. Jul 2005;53(1):108-14. [Medline].

  3. Lambert WC, Brodkin RH. Nodal and subcutaneous cellular blue nevi. A pseudometastasizing pseudomelanoma. Arch Dermatol. Mar 1984;120(3):367-70. [Medline].

  4. Causeret AS, Skowron F, Viallard AM, Balme B, Thomas L. Subungual blue nevus. J Am Acad Dermatol. Aug 2003;49(2):310-2. [Medline].

  5. Cooper PH. Deep penetrating (plexiform spindle cell) nevus. A frequent participant in combined nevus. J Cutan Pathol. Jun 1992;19(3):172-80. [Medline].

  6. Munoz C, Quintero A, Sanchez JL, Ruiz-Santiago H. Persistent blue nevus simulating melanoma. J Am Acad Dermatol. May 2004;50(5 Suppl):S118-20. [Medline].

  7. Braun RP, Rabinovitz HS, Oliviero M, Kopf AW, Saurat JH. Dermoscopy of pigmented skin lesions. J Am Acad Dermatol. Jan 2005;52(1):109-21. [Medline].

  8. Ferrara G, Soyer HP, Malvehy J, et al. The many faces of blue nevus: a clinicopathologic study. J Cutan Pathol. Jul 2007;34(7):543-51. [Medline].

  9. Tsunemi Y, Saeki H, Tamaki K. Blue naevus with pigment network-like structure on dermoscopy. Acta Derm Venereol. 2008;88(4):412-3. [Medline].

  10. Barnhill RL, Barnhill MA, Berwick M, Mihm MC Jr. The histologic spectrum of pigmented spindle cell nevus: a review of 120 cases with emphasis on atypical variants. Hum Pathol. Jan 1991;22(1):52-8. [Medline].

  11. Moreno C, Requena L, Kutzner H, de la Cruz A, Jaqueti G, Yus ES. Epithelioid blue nevus: a rare variant of blue nevus not always associated with the Carney complex. J Cutan Pathol. May 2000;27(5):218-23. [Medline].

  12. Carney JA. Psammomatous melanotic schwannoma. A distinctive, heritable tumor with special associations, including cardiac myxoma and the Cushing syndrome. Am J Surg Pathol. Mar 1990;14(3):206-22. [Medline].

  13. Carney JA, Ferreiro JA. The epithelioid blue nevus. A multicentric familial tumor with important associations, including cardiac myxoma and psammomatous melanotic schwannoma. Am J Surg Pathol. Mar 1996;20(3):259-72. [Medline].

  14. Carney JA, Gordon H, Carpenter PC, Shenoy BV, Go VL. The complex of myxomas, spotty pigmentation, and endocrine overactivity. Medicine (Baltimore). Jul 1985;64(4):270-83. [Medline].

  15. Carney JA, Headington JT, Su WP. Cutaneous myxomas. A major component of the complex of myxomas, spotty pigmentation, and endocrine overactivity. Arch Dermatol. Jul 1986;122(7):790-8. [Medline].

  16. Blackford S, Roberts DL. Familial multiple blue naevi. Clin Exp Dermatol. Jul 1991;16(4):308-9. [Medline].

  17. Maize JC, LeBoit PE, Metcalf JS, et al. Neoplasms of melanocytes. In: Maize J, Burgdorf WHC, Hurt MA, et al, eds. Cutaneous Pathology. Philadelphia, Pa: Churchill Livingstone; 1998:677-82.

  18. Novice FM, Collison DW, Burgdorf WHC, et al. Disorders of hyperpigmentation. In: Novice FM, Collison DW, eds. Handbook of Genetic Skin Disorders. ed. Philadelphia, Pa: WB Saunders; 1994:195-8.

  19. Rhodes AR. Benign neoplasias and hyperplasias of melanocytes. In: Freedberg IM, Eisen AZ, Wolff K, et al, eds. Fitzpatrick's Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999:1037-43.

  20. Rodriguez HA, Ackerman LV. Cellular blue nevus. Clinicopathologic study of forty-five cases. Cancer. Mar 1968;21(3):393-405. [Medline].

  21. Temple-Camp CR, Saxe N, King H. Benign and malignant cellular blue nevus. A clinicopathological study of 30 cases. Am J Dermatopathol. Aug 1988;10(4):289-96. [Medline].

  22. Zembowicz A, Mihm MC. Dermal dendritic melanocytic proliferations: an update. Histopathology. Nov 2004;45(5):433-51. [Medline].

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Further Reading

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Keywords

nevus of Jadassohn and Tieche, blue neuronevus, dermal melanocytoma, common blue nevus, cellular blue nevus, chromatophoroma, melanofibroma

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Contributor Information and Disclosures

Author

Rudolf R Roth, MD, Medical Director, Department of Dermatology, Penn Medicine at Radnor; Associate Professor of Clinical Dermatology, Department of Dermatology, University of Pennsylvania School of Medicine
Rudolf R Roth, MD is a member of the following medical societies: American Academy of Dermatology and Association of Military Dermatologists
Disclosure: Nothing to disclose.

Coauthor(s)

Scott M Acker, MD, Associate Professor, Director of Dermatopathology, Departments of Dermatology and Pathology, University of Alabama at Birmingham
Scott M Acker, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society for Clinical Pathology, and Southern Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Terry L Barrett, MD, Clinical Professor of Dermatology and Pathology, University of Texas Southwestern School of Medicine; Director, ProPath Dermatopathology, Dallas, Texas
Terry L Barrett, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, College of American Pathologists, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory
Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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