Photo Quiz

Pigmented Lesion with a Depigmented Rim

 

Am Fam Physician. 2017 Jul 1;96(1):53-54.

A 15-year-old girl presented with an asymptomatic pigmented mole that had been present for about 10 years. The mole had developed a white halo around it two years earlier. Over the past year, the halo enlarged, while the size and pigmentation of the mole decreased. She was in good health and was not taking any medications. There was no personal or family history of autoimmune disorders or melanoma.

Physical examination revealed a 4-mm, melanocytic nevus surrounded by a rim of depigmentation on the right scapula (Figure 1). No other cutaneous or systemic abnormalities were noted.

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Figure 1.


Figure 1.

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Blue nevus.

B. Halo nevus.

C. Melanoma.

D. Nevus spilus.

E. Spitz nevus.

Discussion

The answer is B: halo nevus. This is a benign lesion characterized by the appearance of a depigmented halo around a central melanocytic nevus. It is common in children and young adults, with a mean age at onset of 15 years, and it most often appears on the upper back.1 Over time, the central nevus may remain brown in color—the classic form of halo nevus (stage I)—or the pigment can disappear, leading to a pink-colored papule (stage II).2 The central nevus may eventually disappear, leading

Author disclosure: No relevant financial affiliations.

Address correspondence to Alexander K.C. Leung, MBBS, at aleung@ucalgary.ca. Reprints are not available from the authors.

REFERENCES

show all references

1. Price A, Polley D, Sabol ME, Elston DM. Dermpath quiz: an irregularly colored papule on the back of an adolescent female. Indian Dermatol Online J. 2015;6(suppl 1):S50–S52....

2. Huynh PM, Lazova R, Bolognia JL. Unusual halo nevi – darkening rather than lightening of the central nevus. Dermatology. 2001;202(4):324–327.

3. Patrizi A, Bentivogli M, Raone B, Dondi A, Tabanelli M, Neri I. Association of halo nevus/i and vitiligo in childhood: a retrospective observational study. J Eur Acad Dermatol Venereol. 2013;27(2):e148–e152.

4. Koga M, Koga K, Kiryu H, Nakayama J. Congenital Spitz nevus on the foot. J Dermatol. 2014;41(3):282–283.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

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