Problems of Differential Diagnosis in Melanoma Arising from Blue Naevus

Open access


Melanoma arising from blue naevus is an exceedingly rare variant of melanoma. Most of the cases are located in head and neck area, with scalp the most affected site. This type of melanoma develops on blue naevus or resembles blue naevus, most frequently cellular blue naevus. We present the case of a 52 years old female diagnosed with a pigmented melanoma of the scalp, with maximum tumoral thickness of 6.8 mm and invasion of the hypodermis, highly resembling cellular blue naevus. All criteria of malignancy were present: prominent nuclear pleomorphism, infiltrative pattern, tumoral necrosis, high mitotic rate (11 mitoses/mm2) with atypical mitosis and high Ki67 index. No lymph node or distant metastases were identified at presentation.

Because of the rarity of cases, histopathological diagnosis can be difficult, differential diagnosis with blue naevi, atypical blue naevi or metastatic melanoma being the most challenging problems. Prognosis is given by tumoral thickness, frequently being more than 4 mm.

1. L. REQUENA, JA CARLSON. Melanoma arising from blue naevus. World Health Organization Classification of Tumours Pathology and Genetics of Skin Tumours, IARC Press, Lyon, 2006, 79-82.

2. MARTIN RC, MURALI R, SCOLYER RA, FITZGERALD P, COLMAN MH, THOMPSON JF. So-called “malignant blue nevus”: A clinicopathologic study of 23 patients. Cancer. 2009 Jul 1; 115(13):2949-55.

3. LOGHAVI S, CURRY JL, TORRES-CABALA CA, IVAN D, PATEL KP, MEHROTRA M, BASSETT R, PRIETO VG, TETZLAFF MT. Melanoma arising in association with blue nevus: A clinical and pathologic study of 24 cases and comprehensive review of the literature. Mod Pathol. 2014 Nov; 27(11):1468-78.

4. KACHARE SD, AGLE SC, ENGLERT ZP, ZERVOS EE, VOHRA NA, WONG JH, FITZGERALD TL. Malignant blue nevus: clinicopathologically similar to melanoma. Am Surg. 2013 Jul; 79(7):651-6.

5. SIHAM LOURARI, LAURENCE LAMANT, ROLAND VIRABEN, CARLE PAUL, NICOLAS MEYER Photoletter to the editor: Blue nevus with satellitosis mimicking melanoma. Contribution of dermoscopy and reflectance confocal microscopy. J Dermatol Case Rep. 2012 June 30; 6(2): 54-56.

6. YONEI N, KIMURA A, FURUKAWA F. Common blue nevus with satellite lesions needs a differential diagnosis from malignant melanoma. Case Rep Dermatol. 2013 Sep 5; 5(3):244-7.

7. HOOS A, BERHO M, BLUMENCRANZ PW, BRADY MS. Giant cellular blue nevus of the anterior chest wall mimicking metastatic melanoma to the breast: A case report. J Surg Oncol. 2000 Aug; 74(4):278-81.

8. CARRERA C, FERRER B, MASCARÓ JM JR, PALOU J. Compound blue naevus: A potential simulator of melanoma. Br J Dermatol. 2006 Jul; 155(1):207-8.

9. DI CESARE A, SERA F, GULIA A, et al. The spectrum of dermatoscopic patterns in blue nevi. J Am Acad Dermatol. 2012; 67:199-205.

10. OLIVEIRA A, ARZBERGER E, MASSONE C, ZALAUDEK I, FINK-PUCHES R, HOFMANN-WELLENHOF R. Melanoma and satellite blue papule. Dermatol Pract Concept. 2014 Jul 31; 4(3):63-6.

11. SANADA S, HIGAKI K, TORII Y, HIGASHI T, YAMAGUCHI R, NAKAMURA Y, YANO H. Malignant melanoma arising in a plaque-type blue nevus. Pathol Int. 2012 Nov; 62(11):749-53.

12. YEH I, FANG Y, BUSAM KJ. Melanoma arising in a large plaque-type blue nevus with subcutaneous cellular nodules. Am J Surg Pathol. 2012 Aug; 36(8):1258-63.

13. LÖFFLER KU, WITSCHEL H. Primary malignant melanoma of the orbit arising in a cellular blue naevus. Br J Ophthalmol. 1989 May; 73(5):388-93.

14. MELLONE P, BIANCHI A, DRAGONETTI E, MURACE R, PERSICHETTI P, BALDI A. Malignant melanoma associated with a blue naevus: A case report. Cases J. 2008 Dec 31; 1(1):433. doi: 10.1186/1757-1626-1-433.

15. NORTH JP, YEH I, MCCALMONT TH, LEBOIT PE. Melanoma ex blue nevus: Two cases resembling large plaque-type blue nevus with subcutaneous cellular nodules. J Cutan Pathol. 2012 Dec; 39(12):1094-9.

16. BIRCH-JOHANSEN FH, SJØSTRAND H, LOCK-ANDERSEN J. Malignant melanoma in association with or mimicking blue naevus. Scand J Plast Reconstr Surg Hand Surg. 2010 Apr; 44(2):118-20.

17. MICHAL M. Cellular blue naevi with microalveolar pattern - a type of naevus frequently confused with melanoma. Pathol Res Pract. 1998; 194(2):83-6.

18. BARNHILL RL, ARGENYI Z, BERWICK M, DURAY PH, ERICKSON L, GUITART J, HORENSTEIN MG, LOWE L, MESSINA J, PAINE S, PIEPKORN MW, PRIETO V, RABKIN MS, SCHMIDT B, SELIM A, SHEA CR, TROTTER MJ. Atypical cellular blue nevi (cellular blue nevi with atypical features): lack of consensus for diagnosis and distinction from cellular blue nevi and malignant melanoma (“malignant blue nevus”). Am J Surg Pathol. 2008 Jan; 32(1):36-44.

19. TRAN TA, CARLSON JA, BASACA PC, MIHM MC. Cellular blue nevus with atypia (atypical cellular blue nevus): A clinicopathologic study of nine cases. J Cutan Pathol. 1998 May; 25(5):252-8.

20. BUSAM KJ. Metastatic melanoma to the skin simulating blue nevus. Am J Surg Pathol. 1999 Mar; 23(3):276-82.

21. GARCÍA-RABASCO A, MARÍN-BERTOLÍN S, ESTEVE-MARTÍNEZ A, ALEGRE-DE-MIQUEL V. Dermal melanocytosis of the scalp associated to intracranial melanoma: malignant blue nevus, neurocutaneous melanosis, or neurocristic cutaneous hamartoma? Am J Dermatopathol. 2012 Apr; 34(2):177-81.

22. LINSKEY KR, DIAS-SANTAGATA D, NAZARIAN RM, LE LP, LAM Q, BELLUCCI KS, ROBINSON-BOSTOM L, MIHM MC JR, HOANG MP. Malignant neurocristic hamartoma: A tumor distinct from conventional melanoma and malignant blue nevus. Am J Surg Pathol. 2011 Oct; 35(10):1570-7.

23. DEYRUP AT, ALTHOF P, ZHOU M, MORGAN M, SOLOMON AR, BRIDGE JA, WEISS SW. Paraganglioma-like dermal melanocytic tumor: A unique entity distinct from cellular blue nevus, clear cell sarcoma, and cutaneous melanoma. Am J Surg Pathol. 2004 Dec; 28(12):1579-86.

24. ZEMBOWICZ A, CARNEY JA, MIHM MC. Pigmented epithelioid melanocytoma: A low-grade melanocytic tumor with metastatic potential indistinguishable from animal-type melanoma and epithelioid blue nevus. Am J Surg Pathol. 2004 Jan; 28(1):31-40.

25. CHANG LM, CASSARINO DS. p16 expression is lost in severely atypical cellular blue nevi and melanoma compared to conventional, mildly, and moderately atypical cellular blue nevi. ISRN Dermatol. 2014 Jan 22; 2014:348-417.

26. BERROCAL A, CABAÑAS L, ESPINOSA E, FERNÁNDEZ-DE-MISA R, MARTÍN-ALGARRA S, MARTÍNEZ-CEDRES JC, RÍOS-BUCETA L, RODRÍGUEZ-PERALTO JL. Melanoma: diagnosis, staging, and treatment. Consensus group recommendations. Adv Ther. 2014 Sep; 31(9):945-60.

27. KARIMKHANI C, GONZALEZ R, DELLAVALLE RP. A review of novel therapies for melanoma. Am J Clin Dermatol. 2014 Aug; 15(4):323-37.

28. MOHAMED A, GONZALEZ RS, LAWSON D, WANG J, COHEN C. Tumor stem cells (CD271, c-kit, SOX10) in Melanomas: prognostic and outcome implications. Appl Immunohistochem Mol Morphol. 2014; 22(2):142-5.

29. GAMMON B, BEILFUSS B, GUITART J, BUSAM KJ, GERAMI P. Fluorescence in situ hybridization for distinguishing cellular blue nevi from blue nevus-like melanoma. J Cutan Pathol. 2011 Apr; 38(4):335-41.

30. GERAMI P, POURYAZDANPARAST P, VEMULA S, BASTIAN BC. Molecular analysis of a case of nevus of ota showing progressive evolution to melanoma with intermediate stages resembling cellular blue nevus. Am J Dermatopathol. 2010 May; 32(3):301-5.

31. POURYAZDANPARAST P, NEWMAN M, MAFEE M, HAGHIGHAT Z, GUITART J, GERAMI P. Distinguishing epithelioid blue nevus from blue nevus-like cutaneous melanoma metastasis using fluorescence in situ hybridization. Am J Surg Pathol. 2009 Sep; 33(9):1396-400.

32. BIRCH-JOHANSEN FH, SJØSTRAND H, LOCK-ANDERSEN J. Malignant melanoma in association with or mimicking blue naevus. Scand J Plast Reconstr Surg Hand Surg. 2010 Apr; 44(2):118-20.

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 81 81 14
PDF Downloads 17 17 3