Aberrant expression of HMB45 and negative PRAME expression in halo nevi.

BACKGROUND: Traditionally, most cutaneous nevi show a gradient of HMB45 (human melanoma black 45) and negative PRAME (preferentially expressed antigen in melanoma) immunostaining, while melanomas often show irregularly positive, diffusely positive or completely negative HMB45 expression, and PRAME immunopositivity. However, we have occasionally observed benign halo nevi with loss of HMB45 gradient, raising diagnostic consideration for melanoma. The purpose of this study was to elucidate the expression pattern of HMB45 and PRAME in nevi with the halo phenomenon (NHP). METHODS: PRAME and HMB45 staining patterns in 20 cases of NHP and 16 cases of conventional nevi were evaluated using light microscopy. An HMB45 gradient was defined as immunopositivity in only superficial melanocytes. HMB45 aberrant expression consisted of superficial and deep immunopositivity. RESULTS: Aberrant HMB45 expression was observed in 10 of 20 NHP (50%). A gradient of HMB45 staining was seen in most conventional nevi, with only one showing focal weak expression in the deep dermis (6.3%). All cases of NHP and conventional nevi showed essentially negative immunostaining by PRAME. CONCLUSION: Aberrant HMB45 expression in NHP is not uncommon and may be a diagnostic pitfall. Negative PRAME immunostaining may be a reassuring finding to help differentiate halo nevus from malignant melanoma.

Mastocitosis cutánea y halo nevus múltiples / Cutaneous mastocytosis and multiple halo nevi

El nevus de Sutton o halo nevus se caracteriza por el desarrollo de un halo acrómico alrededor de uno o varios nevus melanocíticos pigmentados. Las mastocitosis comprenden un grupo heterogéneo de enfermedades que se caracterizan por la acumulación anormal de mastocitos en uno o varios órganos. Se reconocen dos tipos: sistémica y cutánea. Dentro de las cutáneas las más frecuentes son la urticaria pigmentosa y el mastocitoma solitario. Presentamos el caso de un niño de 12 años que presenta lesiones compatibles con halo nevus y urticaria pigmentosa

Sutton's nevus or halo nevus is characterized by the development of an achromic halo around one or more pigmented melanocytic nevi. Mastocytosis comprise a heterogeneous group of diseases characterized by the abnormal accumulation of mast cells in one or more organs. Two types are recognized: systemic and cutaneous. Among the cutaneous ones, the most frequent are urticaria pigmentosa and solitary mastocytoma. We present the case of a 12-year-old boy who presented with lesions compatible with halo nevi and urticaria pigmentosa

Regresión espontánea de tres nevus melanocíticos congénitos medianos / Spontaneous Regression of Medium-Sized Congenital Melanocytic Nevi: Report of 3 New Cases

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Spontaneous Regression of Large Congenital Melanocytic Nevi, With a Halo Rim in 17 Children With Large Scalp and Trunk Nevi During 45 Years: A Review of the Literature.

Background. Prior reports on large congenital melanocytic nevi (LCMN) do not provide a clear management approach to physicians to advise parents or patients. Whether the presence of a halo around the nevus can guide management has not been fully explored. Design. Children born with an LCMN were observed without active intervention. Objectives. (1) To guide physicians, health providers, and parents in the management of CMN. (2) To ascertain the value of the absence or presence of a halo component of the nevi. (3) To reaffirm the diagnostic value of dermoscopy for evaluation of CMN. Materials and Methods. This was a clinical study of 45 children referred to our pediatric dermatology clinics from 1971 to- 2018. Results and Outcome. Of 45 children, 9 were lost to follow-up and 36 were followed for 6 months to 47 years. In follow-up of 17 children with a scalp CMN, spontaneous regression occurred in 6 patients. In follow-up of 5 children with a trunk LCMN, spontaneous regression occurred in 1 patient and excisional surgery was done in 4 patients. Quality of life was excellent in 35 children, but poor in 1 patient during multiple injections and excisions. Conclusions. A conservative approach to management of children with CMN, large and small, is safe, cost-effective, and results in excellent quality of life and cosmetic outcomes. Dermoscopy, a simple in-office procedure, can reassure the examiner that the congenital nevus is benign. A halo rim was present in 12 (80%) of 15 scalp CMN. The presence of a halo rim appears predictive of future regression of a CMN in the scalp or trunk.

The color of skin: white diseases of the skin, nails, and mucosa.

White diseases are a heterogenous group characterized by hypopigmentation or depigmentation. Skin and eye color are determined by the number and size of melanosomes present. Melanin is produced by melanosomes in the melanocytes present within the epidermis of the skin, uvea, and retinal pigmented epithelium (RPE). Conditions altering the number of melanocytes or concentration of melanin result in a lack of pigmentation, appearing as "white diseases" ranging from the well-known albinism and vitiligo to more esoteric white hand syndrome and Degos disease.

Enfermedades poco frecuentes. Halo nevus. Presentación de un caso clínico / Rare diseases. Halo nevus. Presentation of a clinical case

El Halo Nevus consiste en un área hipopigmentada que rodea un nevus melanocítico preexistente y lo hace desaparecer, dejando una cicatriz hipocrómica en el lugar del nevo. Un 20% puede malignizarse. Se presenta un adolescente con lesiones en sus diferentes estados evolutivos, sin sintomatología adicional, ni antecedentes familiares. Es importante el seguimiento clínico y dermatológico para detectar signos tempranos de malignización con el consiguiente tratamiento oportuno

Summary Halo Nevus consists is an hypopigmented area surrounding a pre-existing melanocytic nevus and make it desappared leaving a hypochromic scar in it place, and 20% may become malignant. We present an adolescent with lesions in their different stages of evolution, without additional symptoms or family history. Clinical and dermatological follow-up is important to detect early signs of malignancy with the following timely treatment

Development of Halo Nevi in a Lung Cancer Patient: A Novel Immune-Related Cutaneous Event from Atezolizumab.

Immunotherapy-induced vitiligo is an immune-related adverse event (irAE) observed in metastatic melanoma patients treated with immune checkpoint inhibitors that target the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death-1 (PD-1) pathways. To date, the development of leukoderma, poliosis, and halo nevi during immunotherapy has largely been reported in metastatic melanoma patients. We report a case of immunotherapy-induced leukoderma presenting as halo nevi in a patient with non-small cell lung cancer (NSCLC) treated with atezolizumab, a programmed cell death ligand (PD-L1) antibody. Immunotherapy-induced vitiligo in metastatic melanoma patients may be associated with improved survival, but it remains to be determined whether its occurrence in non-melanoma cancers has the same prognostic significance.

J Drugs Dermatol. 2017;16(10):1047-1049.

Comparison of Childhood Vitiligo Presenting with or without Associated Halo Nevi.

BACKGROUND: Previous studies have characterized differences in vitiligo associated with halo nevi, but the features of vitiligo presenting with halo nevus in children have yet to be fully described. AIMS: We sought to provide an epidemiologic and clinical comparison of cases of childhood vitiligo presenting with or without associated halo nevi. MATERIALS AND METHODS: This was a retrospective chart review of children diagnosed with vitiligo in an academic pediatric dermatology practice from January 1990 to November 2014. The characteristics of children with vitiligo with or without associated halo nevi were compared. RESULTS: Halo nevi were identified in 55 (26%) of 208 children with vitiligo. Patients with halo nevi were significantly more likely to be male and develop vitiligo at a later age. Children with vitiligo associated with halo nevi were more likely to present with generalized vitiligo, defined according to the presence of bilateral macules. DISCUSSION: There was no significant association between groups in the percentage of body surface area with vitiligo or family history of vitiligo or autoimmune diseases. Patients with halo nevi were no more likely to develop new areas of vitiligo during the follow-up period, but there was a nonsignificant trend toward a higher rate of repigmentation in vitiligo associated with halo nevus. CONCLUSION: Halo nevi are a common finding in children with vitiligo. The presence of a halo nevus in a child with vitiligo is associated with generalized vitiligo. The presence of a halo nevus does not significantly alter the risk of disease progression and rate of treatment.

Early-onset childhood vitiligo is associated with a more extensive and progressive course.

OBJECTIVES: Vitiligo commonly presents in children, with half of all cases developing before 20 years of age. Although studies have characterized differences between pediatric and adult vitiligo, little is known about vitiligo presenting in early childhood. The purpose of this study was to compare clinical features of early-onset (<3 years old) and later-onset (3-18 years old) childhood vitiligo. METHODS: This retrospective case series examined patients given a diagnosis of vitiligo in a pediatric dermatology practice at an academic medical center from 1990 to 2014. Characteristics of the early- and later-onset groups were compared by χ(2) and t test for categorical and continuous variables, respectively. RESULTS: Of the 208 children in the study, 31 had early-onset and 177 had later-onset disease. Early-onset vitiligo was associated with higher percentages of body surface area involvement and increased rates of disease progression during an average 1.9 years of follow-up. There were no significant differences between the 2 groups in repigmentation, vitiligo type, halo nevi, gender ratio, or personal and family history of autoimmune diseases. LIMITATIONS: This was a retrospective, single-institution study. CONCLUSION: Patients given a diagnosis of vitiligo at younger ages tend to have more extensive and progressive disease.

A comparative study of mitochondrial ultrastructure in melanocytes from perilesional vitiligo skin and perilesional halo nevi skin.

Vitiligo and halo nevi are both pigmentary disorders of the skin characterized by the acquired loss of functional epidermal melanocytes manifesting as white macules and patches. The cellular mechanism(s) and biochemical changes that result in the appearance of these two types of achromic lesions are still uncertain; and the relationship between vitiligo and halo nevi has been in dispute. In this study, we investigated the ultrastructure of mitochondria in melanocytes and in keratinocytes from perilesional vitiligo skin and from perilesional halo nevi skin using Transmission Electron Microscopy. Furthermore, we performed a quantitative analysis of mitochondrial morphology through a stereological study. As previously reported, we found that melanocytes from perilesional active vitiligo skin were loosely connected with their surroundings by their retracted dendrites. The surface density and the volume density of mitochondria in melanocytes and in keratinocytes from perilesional vitiligo skin are increased significantly compared with the controls, especially in active vitiligo. In contrast, there are no significant differences in mitochondria in melanocytes and in keratinocytes from perilesional halo nevi skin compared with the controls. In summary, the tendency of different morphologic alterations in mitochondria from perilesional vitiligo skin and from perilesional halo nevi skin reflect heterogeneous backgrounds between the two diseases, revealing that vitiligo and halo nevi may have separate pathogenic mechanisms. These findings may help elucidate the relationship of these two diseases and their underlying mechanisms.

Hemangioma hemosiderótico en diana / Targetoid hemosiderotic hemangioma

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Criterios dermatoscópicos de halo nevo y halo melanoma / Dermoscopy criteria of halo nevi and halo melanoma

El fenómeno halo es más común en lesiones melanocíticas benignas. Se han reportado casos de halo nevo en individuos con antecedentes personales o familiares de melanoma como también melanomas con halo lo que ha suscitado preocupaciones acerca del diagnóstico y manejo de estas lesiones. El halo nevo pertenece al grupo de los simuladores de melanoma. A través de una técnica no invasiva como es la dermatoscopia se puede diferenciar las características dermatoscópicas del halo nevo y halo melanoma

Halo phenomenon appears more often in benign melanocytic lesions. There have been reports of halo nevi in individuals with personal or family history of melanoma as well as melanomas with halo, raising concerns about the diagnosis and management of these lesions. Halo nevus belongs to the group of melanoma simulators. Dermoscopic features of halo nevus and melanoma can be differentiated through a noninvasive technique such as dermoscopy.

In vivo reflectance confocal microscopy of halo nevus.

BACKGROUND: RCM (reflectance confocal microscopy) is a noninvasive, high-resolution technology that has been proven to improve the diagnostic accuracy over clinical examination in several skin diseases. OBJECTIVE: The aim of this article is to describe the morphologic features of halo nevi (HN) observed with RCM and correlate them with their dermoscopic characteristics. METHOD: Nine patients with the clinical diagnosis of HN were assessed with RCM. A second assessment was performed up to 12 months later. Dermoscopic global patterns were obtained and correlated with the RCM findings. RESULTS: In five (55.6%) cases, pagetoid cells were observed. Nonedged dermal papilla and junctional thickening were found in three (33%) cases. Nucleated cells in the dermal papillae and plump bright cells were observed in seven (77.8%) and six (66.7%) cases, respectively. CONCLUSION: Our study shows that HN observed by RCM can show atypical features that overlap with those observed on atypical melanocytic lesions and malignant melanoma.