Halo Nevus Clinical Presentation

Author: Edward J Zabawski Jr, DO; Chief Editor: Dirk M Elston, MD more...

Updated: Jan 13, 2012

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History
Physical
Causes
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History

Patients with halo nevi are usually asymptomatic. The central nevus may or may not involute with time. Repigmentation often takes place over months or years; however, it does not always occur. Occasionally, inflammation occurs with crusting in the depigmented zone of a halo nevus. Most commonly, the chief complaint is that of a changing mole (or moles).

Physical

Halo nevi are usually single but may be multiple. They can develop anywhere on the body but are seen most frequently on the trunk. Clinically, they appear as one or more uniformly colored, evenly shaped, round or oval nevi centrally with even peripheral margins of hypopigmentation. The central nevus may be tan, pink, or brown. The width of the halo is variable but is generally of uniform radial distance from the central nevus.

Classic appearance of a halo nevus.

Note the central pink papule (intradermal nevus) and the surrounding halo. The halo is of uniform width at all points, and no inflammatory component can be seen. Note the normal nevus directly inferior.

Causes

The cause is unknown, but halo nevus is believed to be due to an immune response against melanocytes.

Proceed to Differential Diagnoses

Contributor Information and Disclosures

Author

Edward J Zabawski Jr, DO Medical and Surgical Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Clay J Cockerell, MD Director, Clinical Professor, Department of Dermatology, Division of Dermatopathology, University of Texas Southwestern Medical Center

Clay J Cockerell, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, International Academy of Pathology, International AIDS Society, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, Society for Investigative Dermatology, and Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Susan M Swetter, MD Director, Pigmented Lesion and Melanoma Program, Professor, Department of Dermatology, Stanford University Medical Center and Cancer Institute, Veterans Affairs Palo Alto Health Care System

Susan M Swetter, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Clinical Oncology, Eastern Cooperative Oncology Group, Pacific Dermatologic Association, Society for Investigative Dermatology, Society for Melanoma Research, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

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

Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

Happle R. [Grunewald nevus]. Hautarzt. Dec 1994;45(12):882-3. [Medline].
Zeff RA, Freitag A, Grin CM, Grant-Kels JM. The immune response in halo nevi. J Am Acad Dermatol. Oct 1997;37(4):620-4. [Medline].
Patrizi A, Neri I, Sabattini E, Rizzoli L, Misciali C. Unusual inflammatory and hyperkeratotic halo naevus in children. Br J Dermatol. Feb 2005;152(2):357-60. [Medline].
van Geel N, Vandenhaute S, Speeckaert R, et al. Prognostic value and clinical significance of halo naevi regarding vitiligo. Br J Dermatol. Apr 2011;164(4):743-9. [Medline].
Fishman HC. Letter: Malignant melanoma arising with two halo nevi. Arch Dermatol. Mar 1976;112(3):407-8. [Medline].
Jacobs JB, Edelstein LM, Snyder LM, Fortier N. Ultrastructural evidence for destruction in the halo nevus. Cancer Res. Feb 1975;35(2):352-7. [Medline].
Herd RM, Hunter JA. Familial halo naevi. Clin Exp Dermatol. Mar 1998;23(2):68-9. [Medline].
Brazzelli V, Larizza D, Martinetti M, et al. Halo nevus, rather than vitiligo, is a typical dermatologic finding of turner's syndrome: clinical, genetic, and immunogenetic study in 72 patients. J Am Acad Dermatol. Sep 2004;51(3):354-8. [Medline].
Zalaudek I, Moscarella E, Argenziano G. Artifactual "pseudo-halo nevi" secondary to sunscreen application. J Am Acad Dermatol. Jun 2006;54(6):1106-7. [Medline].
Berg P, Lindelof B. Differences in malignant melanoma between children and adolescents. A 35-year epidemiological study. Arch Dermatol. Mar 1997;133(3):295-7. [Medline].

Classic appearance of a halo nevus.

At low magnification, a dome-shaped papular lesion reveals a dense infiltrate of lymphocytes in the dermis (hematoxylin and eosin, original magnification X40).

Higher magnification reveals nests of nevus cells with numerous lymphocytes surrounding them and in the interstitium (hematoxylin and eosin, original magnification X40).

Table. Distinguishing Features of Halo Nevus and Melanoma

Table. Distinguishing Features of Halo Nevus and Melanoma

Halo Nevus	Melanoma
Nevus cells in nests	Single atypical melanocytes at all levels of the epidermis and aggregates of atypical melanocytes in the dermis
Lesion symmetrical	Lesion asymmetrical
Maturation of nevus cells	Lack of maturation
Mitotic figures rare or absent	Mitotic figures present
Lymphocytic infiltrate present diffusely throughout lesion	Lymphocytic infiltrate tends to be at be concentrated at periphery

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