eMedicine Specialties > Dermatology > Benign Neoplasms

Halo Nevus

Author: Edward J Zabawski Jr, DO, RPh, Dermatologist, Spencer Dermatology Group
Coauthor(s): Clay J Cockerell, MD, Director, Clinical Professor, Department of Dermatology, Division of Dermatopathology, University of Texas Southwestern Medical Center
Contributor Information and Disclosures

Updated: May 28, 2009

Introduction

Background

Halo nevi are common benign skin lesions that represent melanocytic nevi in which an inflammatory infiltrate develops, resulting in a zone of depigmentation surrounding the nevus. Although Sutton originally described the lesion in 1916 as leukoderma acquisita centrifugum, the lesions were noted earlier, as evidenced by their depiction in the painting The Temptation of Saint Anthony by Matthias Gr ü nwald circa 1512-1516.1

Because melanoma that has undergone regression may appear gray or white, halo nevi have been erroneously confused with melanoma and have been the source of much anxiety among both clinicians and patients. Nevertheless, they are entirely benign lesions and of only cosmetic significance.

Pathophysiology

The etiology of halo nevi is unknown. Numerous studies have attempted to unravel the immunologic mechanisms by which an immune response develops to existing aggregates of nevus cells.2 The infiltrating cells are predominantly T-lymphocytes, and cytotoxic (CD8) lymphocytes outnumber helper (CD4) lymphocytes by a ratio of approximately 4:1. These, as well as scattered macrophages, comprise most inflammatory cells in halo nevi.3 As seen in vitiligo, melanocytes in the epidermis in the halo component of the nevus are completely absent, suggesting a similar etiologic mechanism. The exact role that the lymphocytes play in the regression of halo nevi has not been fully determined, although a theory of direct cytotoxic effects on melanocytes seems plausible.

Of interest, circulating antibodies to the cytoplasm of melanoma cells have been detected in patients with halo nevi.4 Because these antibodies have disappeared after removal of the halo nevus, they were thought to be related. Subsequent investigation failed to reveal a temporal relation between the appearance of these antibodies and the regression of nevus cells, and these antibodies are now believed to appear as a consequence of the release of cytoplasmic proteins of halo nevus melanocytes secondary to cell damage.

Ultrastructurally, advanced lesions of halo nevus show dermal macrophages containing portions of nevus cells. While it is clear that an immunologic mechanism results in the demise of melanocytes in halo nevi, the precipitating cause and the exact role of the lymphocytes remain unknown.5

Frequency

United States

The incidence of halo nevi in the population is estimated to be 1%.6 Patients with Turner syndrome have been reported to have an increased incidence of halo nevi.7

Mortality/Morbidity

Halo nevi are benign. Morbidity is minimal and limited to cosmetic appearance.

Race

All races are susceptible to the development of these lesions. A familial tendency for halo nevi has been reported.

Sex

No sexual predilection is reported.

Age

Halo nevi are found most commonly in children. The average age of onset is 15 years.

Clinical

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.

Classic appearance of a halo nevus.

Classic appearance of a halo nevus.

Classic appearance of a halo nevus.



Note the central pink papule (intradermal 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.

Note the central pink papule (intradermal 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.

More on Halo Nevus

Overview: Halo Nevus
Differential Diagnoses & Workup: Halo Nevus
Treatment & Medication: Halo Nevus
Follow-up: Halo Nevus
Multimedia: Halo Nevus
References

References

  1. Happle R. [Grunewald nevus]. Hautarzt. Dec 1994;45(12):882-3. [Medline].

  2. 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].

  3. 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].

  4. Fishman HC. Letter: Malignant melanoma arising with two halo nevi. Arch Dermatol. Mar 1976;112(3):407-8. [Medline].

  5. 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].

  6. Herd RM, Hunter JA. Familial halo naevi. Clin Exp Dermatol. Mar 1998;23(2):68-9. [Medline].

  7. 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].

  8. 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].

  9. 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].

Further Reading

Keywords

halo nevus, nevus of Sutton, halo nevi, Sutton nevus, Sutton nevi, melanoma, malignant melanoma

Contributor Information and Disclosures

Author

Edward J Zabawski Jr, DO, RPh, Dermatologist, Spencer Dermatology Group
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.

Medical Editor

Susan M Swetter, MD, Director, Pigmented Lesion and Cutaneous Melanoma Clinic, Associate Professor, Department of Dermatology, Stanford University Medical Center, 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.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University 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.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-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.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine 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, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
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; american college of physicians Honoraria Other

RELATED EMEDICINE ARTICLES
Patient Education
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.