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Year : 2014  |  Volume : 15  |  Issue : 2  |  Page : 102-103

Spontaneous regression of a medium sized congenital melanocytic nevus


Department of Dermatology, Complejo Asistencial Universitario de León, C/Altos de Nava s/n CP: 24071, León, Spain

Date of Web Publication27-Aug-2014

Correspondence Address:
María Mercedes Otero Rivas
Department of Dermatology, Complejo Asistencial Universitario de León, C/Altos de Nava s/n CP: 24071, León
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.139517

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How to cite this article:
Rivas MO, Vicente SD, Narganes LV, González ES. Spontaneous regression of a medium sized congenital melanocytic nevus. Indian J Paediatr Dermatol 2014;15:102-3

How to cite this URL:
Rivas MO, Vicente SD, Narganes LV, González ES. Spontaneous regression of a medium sized congenital melanocytic nevus. Indian J Paediatr Dermatol [serial online] 2014 [cited 2019 Dec 14];15:102-3. Available from: http://www.ijpd.in/text.asp?2014/15/2/102/139517

Sir,

An otherwise healthy 15-year-old female patient was regularly followed in our Pediatric Dermatology Clinic since she was only 21 months of age because she presented an 8 × 3 cm. congenital melanocytic nevus (CMN) in her right upper limb. In the last visit, she claimed that the lesion had started to fade some months ago. On skin examination, a subtle peripheral loss of melanocytic pigmentation was observed. No halo or eczema was appreciated and the lesion remained asymptomatic [Figure 1]a]. In the area of pigmentation, dermoscopy showed coarse terminal hair and globules of pigment in a typical CMN fashion [Figure 1]b]. Meanwhile, the areas of regression showed whitish homogeneous areas [Figure 1]c]. On clinical and dermoscopic follow-up, the nevus is still undergoing these changes.
Figure 1: (a) Congenital melanocytic nevus, note the central zone with pigmentation and the peripheral rim of normal colored skin; (b) Coarse terminal hair and globules of pigment without any atypical findings; (c) Whitish homogeneous regression in the depigmented area

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We performed a skin biopsy under local anesthesia. The H and E stain showed a predominantly dermal benign melanocytic proliferation admixed with an intense lymphocytic infiltrate. There was no sign of concurrent spongiotic dermatitis in the dermoepidermal junction [Figure 2]a]. Under inmunohistochemical stains, these cells revealed as CD8+ lymphocytes [Figure 2]b].
Figure 2: (a) H and E, (×4) nests of melanocytic nevus cells extending into the deep dermis around a hair follicle; (b) Admixed infiltrate of predominantly CD8+ lymphocytes

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Given these findings we concluded that the nevus was undergoing a spontaneous regression which may be related either to an autoimmune process with melanocytic apoptosis or loss of melanin synthesis by the melanocytic cells.

Few cases have been reported of CMN with spontaneous regression without associated halo phenomenon (Sutton nevus) or eczema (Meyerson nevus). [1]

Sutton's nevus, also known as halo nevus or leukoderma adquisitum centrifugum, is a well-known phenomenon in acquired melanocytic nevus (around 1% in Caucasians), characterized by progressive lightening in a rounded, symmetric pattern. However, its occurrence in CMN is exceptional. [2] A dense infiltrate of predominantly CD8+ lymphocytes can be seen around the rests of a regressed melanocytic lesion.

Meyerson nevus is characterized by the presence of an eczematous dermatitis, with scaling and inflammation, around a melanocytic nevus. Histopathology shows a melanocytic lesion (congenital or acquired) with associated spongiotic dermatitis, without the involution of the former seen in halo nevus. Lymphocytic infiltrate is mainly composed of CD4+ lymphocytes.

Spontaneous regression of CMN is believed to express an autoimmune process that can be related to the destruction of melanocytic nevus cells or cessation of pigment production. [3] Melanocytic nevus cells express major histocompatibility complex class I antigens which allows recognition as a target for cytotoxic T cells. [4]

To conclude with, we present a case of spontaneous incomplete regression of a medium sized CMN. The differential diagnoses include halo nevus and Meyerson's phenomenon. Once excluded any atypical findings, no intervention is advised.

 
  References Top

1.Nath AK, Thappa DM, Rajesh NG. Spontaneous regression of a congenital melanocytic nevus. Indian J Dermatol Venereol Leprol 2011;77:507-10.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Tokura Y, Yamanaka K, Wakita H, Kurokawa S, Horiguchi D, Usui A, et al. Halo congenital nevus undergoing spontaneous regression. Involvement of T-cell immunity in involution and presence of circulating anti-nevus cell IgM antibodies. Arch Dermatol 1994;130:1036-41.  Back to cited text no. 2
    
3.Martín JM, Jordá E, Calduch L, Alonso V, Revert A. Progressive depigmentation of a palmar congenital melanocytic nevus without an associated halo phenomenon. Dermatology 2006;212:198-9.  Back to cited text no. 3
    
4.Langer K, Konrad K. Congenital melanocytic nevi with halo phenomenon: Report of two cases and a review of the literature. J Dermatol Surg Oncol 1990;16:377-80.  Back to cited text no. 4
    


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