Halo Nevus Workup

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

Updated: Jan 13, 2012

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Other Tests

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

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.

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 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).

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 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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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.

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

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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