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Blue Nevi

  • Author: Rudolf R Roth, MD; Chief Editor: William D James, MD  more...
 
Updated: Feb 08, 2016
 

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.[1] 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.[2]

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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 blue nevi show fewer BRAF mutations compared with congenital and acquired nevi,[3] but they show somatic mutations in the heterotrimeric G protein α-subunit, GNAQ, in up to 83% of cases.[4, 5]

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Epidemiology

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.

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.

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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, 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, Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

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, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

References
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Common blue nevus on the scalp.
Common blue nevus on the hand.
Common blue nevus. Numerous elongated dendritic melanocytes with a subepidermal grenz zone. Courtesy of Rose Elenitsas, MD.
Cellular blue nevus. Deep proliferation of dendritic melanocytes, broader at the surface than the base, with islands of paler cells with larger nuclei. Courtesy of Rose Elenitsas, MD.
 
 
 
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