- Author: Rudolf R Roth, MD; Chief Editor: William D James, MD more...
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.
In addition to the common blue nevus and the cellular blue nevus, there are variants similar to typical nevi, such as the combined blue nevus, the sclerosing (desmoplastic) blue nevus, the amelanotic blue nevus, and the epitheliod blue nevus.
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.
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.
The international incidence of blue nevi varies with the population examined.
Blue nevi are twice as common in women than in men.
Blue nevi may develop at any age but are usually noticed in the second decade of life or later.
Phadke PA, Zembowicz A. Blue nevi and related tumors. Clin Lab Med. 2011 Jun. 31(2):345-58. [Medline].
Zembowicz A, Phadke PA. Blue nevi and variants: an update. Arch Pathol Lab Med. 2011 Mar. 135 (3):327-36. [Medline].
Gill M, Celebi JT. B-RAF and melanocytic neoplasia. J Am Acad Dermatol. 2005 Jul. 53(1):108-14. [Medline].
Van Raamsdonk CD, Bezrookove V, Green G, Bauer J, Gaugler L, O'Brien JM, et al. Frequent somatic mutations of GNAQ in uveal melanoma and blue naevi. Nature. 2009 Jan 29. 457 (7229):599-602. [Medline].
Emley A, Nguyen LP, Yang S, Mahalingam M. Somatic mutations in GNAQ in amelanotic/hypomelanotic blue nevi. Hum Pathol. 2011 Jan. 42(1):136-40. [Medline].
Di Cesare A, Sera F, Gulia A, Coletti G, Micantonio T, Fargnoli MC, et al. The spectrum of dermatoscopic patterns in blue nevi. J Am Acad Dermatol. 2011 Oct 24. [Medline].
Dailey VL, Hameed O. Blue nevus of the prostate. Arch Pathol Lab Med. 2011 Jun. 135(6):799-802. [Medline].
Causeret AS, Skowron F, Viallard AM, Balme B, Thomas L. Subungual blue nevus. J Am Acad Dermatol. 2003 Aug. 49(2):310-2. [Medline].
Cooper PH. Deep penetrating (plexiform spindle cell) nevus. A frequent participant in combined nevus. J Cutan Pathol. 1992 Jun. 19(3):172-80. [Medline].
Munoz C, Quintero A, Sanchez JL, Ruiz-Santiago H. Persistent blue nevus simulating melanoma. J Am Acad Dermatol. 2004 May. 50(5 Suppl):S118-20. [Medline].
Carney JA. Psammomatous melanotic schwannoma. A distinctive, heritable tumor with special associations, including cardiac myxoma and the Cushing syndrome. Am J Surg Pathol. 1990 Mar. 14(3):206-22. [Medline].
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. 1996 Mar. 20(3):259-72. [Medline].
Carney JA, Gordon H, Carpenter PC, Shenoy BV, Go VL. The complex of myxomas, spotty pigmentation, and endocrine overactivity. Medicine (Baltimore). 1985 Jul. 64(4):270-83. [Medline].
Carney JA, Headington JT, Su WP. Cutaneous myxomas. A major component of the complex of myxomas, spotty pigmentation, and endocrine overactivity. Arch Dermatol. 1986 Jul. 122(7):790-8. [Medline].
Kirschner LS, Sandrini F, Monbo J, Lin JP, Carney JA, Stratakis CA. Genetic heterogeneity and spectrum of mutations of the PRKAR1A gene in patients with the carney complex. Hum Mol Genet. 2000 Dec 12. 9 (20):3037-46. [Medline].
Blackford S, Roberts DL. Familial multiple blue naevi. Clin Exp Dermatol. 1991 Jul. 16(4):308-9. [Medline].
Braun RP, Rabinovitz HS, Oliviero M, Kopf AW, Saurat JH. Dermoscopy of pigmented skin lesions. J Am Acad Dermatol. 2005 Jan. 52(1):109-21. [Medline].
Ferrara G, Soyer HP, Malvehy J, et al. The many faces of blue nevus: a clinicopathologic study. J Cutan Pathol. 2007 Jul. 34(7):543-51. [Medline].
Di Cesare A, Sera F, Gulia A, Coletti G, Micantonio T, Fargnoli MC, et al. The spectrum of dermatoscopic patterns in blue nevi. J Am Acad Dermatol. 2012 Aug. 67 (2):199-205. [Medline].
Tsunemi Y, Saeki H, Tamaki K. Blue naevus with pigment network-like structure on dermoscopy. Acta Derm Venereol. 2008. 88(4):412-3. [Medline].
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. 1991 Jan. 22(1):52-8. [Medline].
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. 2000 May. 27(5):218-23. [Medline].
Loghavi S, Curry JL, Torres-Cabala CA, Ivan D, Patel KP, Mehrotra M, et al. Melanoma arising in association with blue nevus: a clinical and pathologic study of 24 cases and comprehensive review of the literature. Mod Pathol. 2014 Nov. 27 (11):1468-78. [Medline].
Lambert WC, Brodkin RH. Nodal and subcutaneous cellular blue nevi. A pseudometastasizing pseudomelanoma. Arch Dermatol. 1984 Mar. 120(3):367-70. [Medline].
Maize JC, LeBoit PE, Metcalf JS, et al. Neoplasms of melanocytes. Maize J, Burgdorf WHC, Hurt MA, et al, eds. Cutaneous Pathology. Philadelphia, Pa: Churchill Livingstone; 1998. 677-82.
Novice FM, Collison DW, Burgdorf WHC, et al. Disorders of hyperpigmentation. Novice FM, Collison DW, eds. Handbook of Genetic Skin Disorders. 1st ed. Philadelphia, Pa: WB Saunders; 1994. 195-8.
Rhodes AR. Benign neoplasias and hyperplasias of melanocytes. 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.