Blue Nevi Workup

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

Laboratory Studies

  • Laboratory studies are not necessary.
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Imaging Studies

  • Imaging studies generally are not necessary; however, dermoscopy is a useful method for separating common blue nevi from a melanoma. The classic dermatoscope features include a homogeneous steel-blue color with no pigment network, no aggregated globules, and no branched streaks,[10, 11] although variations, including blue globules and dots and pigmented networks, have been reported.[12]
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Histologic Findings

A histologic continuum exists from common blue nevi to cellular blue nevi.

In common blue nevus, a vaguely nodular collection of poorly melanized spindled melanocytes and deeply pigmented dendritic melanocytes within thickened collagen bundles is seen. Scattered melanophages are usually noted. No mitoses are present.

Common blue nevus. Numerous elongated dendritic meCommon blue nevus. Numerous elongated dendritic melanocytes with a subepidermal grenz zone. Courtesy of Rose Elenitsas, MD.

In cellular blue nevus, a well-demarcated nodule formed by fascicles and nests of tightly packed, moderately sized, spindled to oval melanocytes with scattered melanophages is seen. The lesion is centered in the reticular dermis; blunt-ended, bulbus extensions that extend into the subcutaneous fat may be noted. Occasional mitoses may be present, but significant cytologic atypia and areas of necrosis are absent. Often, a component of common blue nevus is seen within these lesions.

Cellular blue nevus. Deep proliferation of dendritCellular 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.

A number of variants of blue nevi with corresponding histologic changes have been described, including epithelioid blue nevus (classic description is with the Carney complex, but also is seen without this condition), atypical blue nevus, deep penetrating blue nevus, sclerosing blue nevus, and amelanotic blue nevus.[13, 14]

The term malignant blue nevus is synonymous with malignant melanoma arising in association with a cellular blue nevus or growing in a histologic pattern similar to that of a cellular blue nevus. These lesions typically have a pronounced cytologic atypia, hyperchromasia, necrosis, an increased mitotic rate, and an infiltrative growth pattern. Complete excision with a margin of healthy skin should be performed.

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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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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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