Blue Nevi 

  • Author: Rudolf R Roth, MD; Chief Editor: William D James, MD   more...
 
Updated: Jan 12, 2012
 

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.

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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 and cellular blue nevi are not associated with chromosomal aberrations,[2] and they show fewer B-RAF mutations compared with congenital and acquired nevi.[3]

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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.

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.[4]

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 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.

Specialty Editor Board

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.

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

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.

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.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

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 and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

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  20. Emley A, Nguyen LP, Yang S, Mahalingam M. Somatic mutations in GNAQ in amelanotic/hypomelanotic blue nevi. Hum Pathol. Jan 2011;42(1):136-40. [Medline].

  21. 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.

  22. 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.

  23. 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.

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

 
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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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