Halo Nevus Workup

  • Author: Edward J Zabawski, Jr, DO; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Aug 15, 2016
 

Other Tests

Performing an examination using a Wood lamp may aid in differentiating halo nevi from other disorders.

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Procedures

Lesions that are not uniform in shape and color or that have a papular component that is not centrally located should be considered for biopsy to exclude the presence of melanocytic atypia.

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Histologic Findings

The histology of halo nevus is variable depending on the age of the lesion; however, in most cases, a dense, somewhat bandlike lymphocytic infiltrate is present in the papillary and often reticular dermis with nests of nevus cells located centrally. The lesion usually demonstrates a dome-shaped architecture similar to that seen in noninflamed nevi. Identifying residual nevus cells may be difficult in some cases, particularly with older lesions or those in which the infiltrate is quite dense. Mitotic figures usually are not seen, although occasional apoptotic cells may be identified. Macrophages may be seen within the infiltrate, some of which are laden with melanin, although, surprisingly, the number of melanophages is less than would be expected in an inflamed melanocytic lesion.

At low magnification, a dome-shaped papular lesionAt 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 Higher magnification reveals nests of nevus cells with numerous lymphocytes surrounding them and in the interstitium (hematoxylin and eosin, original magnification X40).

In more mature lesions, nevus cells may appear to be absent or decreased in number. Clinically, a noninflammatory halo nevus may demonstrate a halo, but, histologically, virtually no inflammatory infiltrate may be present. Conversely, some nevi may demonstrate marked inflammation, but, clinically, no halo is visible. Therefore, clinical correlation is important in rendering a diagnosis of halo nevus. The most important lesion to differentiate from halo nevus is melanoma (see Table).

Table. Distinguishing Features of Halo Nevus and Melanoma (Open Table in a new window)

Halo NevusMelanoma
Nevus cells in nestsSingle atypical melanocytes at all levels of the epidermis and aggregates of atypical melanocytes in the dermis
Lesion symmetricalLesion asymmetrical
Maturation of nevus cellsLack of maturation
Mitotic figures rare or absentMitotic figures present
Lymphocytic infiltrate present diffusely throughout lesionLymphocytic infiltrate tends to be at be concentrated at periphery
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Contributor Information and Disclosures
Author

Edward J Zabawski, Jr, DO Medical and Surgical Dermatology

Edward J Zabawski, Jr, DO is a member of the following medical societies: American Osteopathic Association, New England Dermatological Society

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 AIDS Society, International Academy of Pathology, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, Society for Investigative Dermatology, Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate 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, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

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, Women's Dermatologic Society, American Society of Clinical Oncology, Society for Melanoma Research, Eastern Cooperative Oncology Group, American Medical Association, Pacific Dermatologic Association, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

References
  1. Happle R. [Grunewald nevus]. Hautarzt. 1994 Dec. 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. 1997 Oct. 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. 2005 Feb. 152(2):357-60. [Medline].

  4. van Geel N, Vandenhaute S, Speeckaert R, et al. Prognostic value and clinical significance of halo naevi regarding vitiligo. Br J Dermatol. 2011 Apr. 164(4):743-9. [Medline].

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

  6. Jacobs JB, Edelstein LM, Snyder LM, Fortier N. Ultrastructural evidence for destruction in the halo nevus. Cancer Res. 1975 Feb. 35(2):352-7. [Medline].

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

  8. 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. 2004 Sep. 51(3):354-8. [Medline].

  9. Jalalabadi F, Trost JG, Cox JA, Lee EI, Pourciau CY. Common Pediatric Skin Lesions: A Comprehensive Review of the Current Literature. Semin Plast Surg. 2016 Aug. 30 (3):91-7. [Medline].

  10. Zalaudek I, Moscarella E, Argenziano G. Artifactual "pseudo-halo nevi" secondary to sunscreen application. J Am Acad Dermatol. 2006 Jun. 54(6):1106-7. [Medline].

  11. Berg P, Lindelof B. Differences in malignant melanoma between children and adolescents. A 35-year epidemiological study. Arch Dermatol. 1997 Mar. 133(3):295-7. [Medline].

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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.
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
Halo NevusMelanoma
Nevus cells in nestsSingle atypical melanocytes at all levels of the epidermis and aggregates of atypical melanocytes in the dermis
Lesion symmetricalLesion asymmetrical
Maturation of nevus cellsLack of maturation
Mitotic figures rare or absentMitotic figures present
Lymphocytic infiltrate present diffusely throughout lesionLymphocytic infiltrate tends to be at be concentrated at periphery
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