10.5826/dpc.1201a16
text/xml
2160-9381
1718
en
Bengü Çobanoğlu  Şimşek
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
halo phenomenon
Large Congenital Melanocytic Nevus With Halo Phenomenon
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-02-02
2021-03-13
2022-02-02
2022-02-09
e2022016
Dermatol Pract Concept
Bengü Çobanoğlu  Şimşek
2022/02/02
10.5826/dpc.1201a16
e2022016
Department of Pathology, Istanbul Medeniyet University, Goztepe Suleyman Yalcin City Hospital, Istanbul, Turkey
2160-9381
halo phenomenon
en
e2022016
Lee NR, Chung HC, Hong H, Lee JW, Ahn SK. Spontaneous involution of congenital melanocytic nevus with halo phenomenon. Am J Dermatopathol. 2015;37(12):e137-e139. DOI: 10.1097/DAD.0000000000000311. PMID: 26588343. PMCID: PMC4894811.
Large Congenital Melanocytic Nevus With Halo Phenomenon
https://dpcj.org/index.php/dpc/article/download/1718/1500
      Large Congenital Melanocytic Nevus With Halo
                      Phenomenon
               Filiz Cebeci1, Hasan Aksoy1, Zeynep Arslan1, Bengü Çobanoğlu Şimşek2


1 Department of Dermatology, Istanbul Medeniyet University, Goztepe Suleyman Yalcin City Hospital, Istanbul, Turkey
2 Department of Pathology, Istanbul Medeniyet University, Goztepe Suleyman Yalcin City Hospital, Istanbul, Turkey



Key words: Congenital melanocytic nevus, Halo phenomenon
Citation: Cebeci F, Aksoy H, Arslan Z, Şimşek BC. Large congenital melanocytic nevus with halo phenomenon.
Dermatol Pract Concept. 2022;12(1):e2022016. DOI: https://doi.org/10.5826/dpc.1201a16
Accepted: May 8, 2021; Published: January 2022
Copyright: ©2022 Cebeci et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License
BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors
and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Filiz Cebeci Assoc. Prof, Department of Dermatology, Istanbul Medeniyet University, Goztepe Suleyman Yalcin City
Hospital, Istanbul, Turkey. Email: E-mail:cebecifiliz@yahoo.com




Introduction                                                             of the skin was noted to develop around it. On physical ex-
                                                                         amination, there was a 12 cm × 5.5 cm ellipsoid pigmented
Congenital melanocytic nevus (CMN) is a pigmented lesion                 patch containing irregularly mottled hypopigmentation and
present at birth or appearing in the first few weeks of life,            few depigmented terminal hairs, surrounded by a 0.5-cm
with an incidence of 0.6%-1.6% among newborns. It de-                    wide depigmented halo-like patch (Figure 1A). Dermoscopy
velops from neural crest-derived melanocytes and usually                 showed regular network and globules, suggesting that the
enlarges throughout childhood. A CMN may remain un-                      pigmented patch was melanocytic in origin (Figure 1B). The
changed or present a dynamic course [1,2]. Halo nevus or                 lesion was biopsied and histopathology revealed hypermel-
leukoderma acquisitum centrifugum can be defined by the                  anosis at the basal cell layer, nests of nevomelanocytes in
presence of circular depigmentation around an acquired or                the dermis and periadnexial lymphocytic infiltration; in the
congenital nevus; a halo can also develop around a mela-                 areas corresponding to the depigmented part of the lesion,
noma. Herein, we report a male adolescent with halo phe-                 epidermal melanin and dermal nevus cells were notably ab-
nomenon around a large CMN, an uncommon finding.                         sent (Figure 2, A-D). Based on the clinical and histopatho-
                                                                         logical findings, the diagnosis was a large CMN with a halo
                                                                         phenomenon.
Case Presentation
A 14-year-old boy was admitted to our department due to
                                                                         Conclusions
complaint of enlargement and color change of a nevus on
his right shin. The lesion had been present since birth and              A halo phenomenon around a nevus has been suggested to be
has grown over the years; during the past year, whitening                due to immunologic responses against melanocytes mediated




Research Letter | Dermatol Pract Concept. 2022;12(1):e2022016                                                                           1
                     Figure 1. (A) Melanocytic patch with irregularly mottled hypopigmentation, depigmented ter-
                     minal hairs, and a depigmented halo. (B) Regular network, a few pigmented globules, and de-
                     pigmented areas on dermoscopy.




Figure 2. Histopathology of the lesion. (A) Intradermal nevoid nests consistent with congenital melanocytic nevus. (B) Hypermelanosis in
the epidermal basal cell layer corresponding to the hyperpigmented area. (C) Loss of epidermal melanin and dermal nevomelanocytes corre-
sponding to the depigmented part of the lesion (H&E, ×200). (D) Loss of melanin in the basal cell layer (Masson-Fontana, ×400).



2                                                                         Research Letter | Dermatol Pract Concept. 2022;12(1):e2022016
by cytotoxic T-cells or immunoglobulin M autoantibodies         conversion to malignant melanoma, and thus it is important
[2]. Unlike acquired nevi, the development of halo around a     to be aware of this phenomenon to avoid premature surgery,
large congenital nevus is less common. Halo around CMN          especially in children.
may also be accompanied by vitiligo. A CMN with a halo
may eventuate in partial or complete regression of the pig-     Informed consent: Informed consent for publication of clini-
mented lesion with progressive depigmentation, remain sta-      cal details and clinical images was obtained from the patient.
ble, or undergo repigmentation. Spontaneous involution of a
CMN is uncommon [1,2]. Halo phenomenon around a
                                                                References
CMN usually causes anxiety and may result in unnecessary
surgical procedures. However, it is usually a benign condi-      1. Karvonen SL, Vaajalahti P, Marenk M, Janas M, Kuokkanen
tion and CMN patients with halo phenomenon should be                K. Birthmarks in 4346 Finnish newborns. Acta Derm Venereol.
                                                                    1992;72(1):55-57. PMID: 1350148.
followed up periodically, just as those with CMN without
                                                                 2. Lee NR, Chung HC, Hong H, Lee JW, Ahn SK. Spontaneous
a halo phenomenon. It is suggested that a conservative ap-
                                                                    involution of congenital melanocytic nevus with halo phenom-
proach and dermoscopic follow-up are safe for children with         enon. Am J Dermatopathol. 2015;37(12):e137-e139. DOI:
a CMN. Development of depigmentation around or within               10.1097/DAD.0000000000000311. PMID: 26588343. PMCID:
the CMN may be confused with pigmentary regression and              PMC4894811.




Research Letter | Dermatol Pract Concept. 2022;12(1):e2022016                                                                 3
