10.5826/dpc.1203a109
text/xml
2160-9381
2057
en
Mario Vaccaro
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
amelanotic melanoma
A pink nodule with white halo: dermoscopy of halo melanoma
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-07-28
2021-09-20
2022-07-28
2022-09-13
e2022109
Dermatol Pract Concept
Mario Vaccaro
2022/07/28
10.5826/dpc.1203a109
e2022109
Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
2160-9381
amelanotic melanoma
en
e2022109
Conforti C, Zelin E, Dri A, et al. Hypomelanotic halo melanoma: dermoscopic findings. Ital J Dermatol Venerol. 2021;156(3):408-409. DOI: 10.23736/S0392-0488.20.06727-9. PMID: 33084271.
A pink nodule with white halo: dermoscopy of halo melanoma
https://dpcj.org/index.php/dpc/article/download/2057/1656
                    Dermatology Practical & Conceptual


          A Pink Nodule With White Halo: Dermoscopy
                      of Halo Melanoma
         Francesco Borgia1, Luca Di Bartolomeo1, Marialorena Coppola1, Maria Lentini2,
                               Elvira Moscarella3, Mario Vaccaro1


1 Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
2 Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Messina, Italy.
3 Dermatology Unit, University of Campania “L. Vanvitelli”, Naples, Italy.



Keywords: melanoma, dermoscopy, halo nevus, amelanotic melanoma
Citation: Borgia F, Di Bartolomeo L, Coppola M, Lentini M, Moscarella E, Vaccaro M. A pink nodule with white halo: dermoscopy of halo
melanoma. Dermatol Pract Concept. 2022;12(3):e2022109. DOI: https://doi.org/10.5826/dpc.1203a109
Accepted: November 8, 2021; Published: July 2022
Copyright: ©2022 Borgia et al. This is an open-access article distributed under the terms of the Creative Commons Attribution
License (BY-NC-4.0), https://creativecommons.org/licenses/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: Luca Di Bartolomeo, MD. Department of Clinical and Experimental Medicine, University Hospital G. Martino, via
Consolare Valeria, 98125 Messina, Italy. E-mail: lucadibartolomeo@live.it




Introduction                                                             2.5 cm x 2 cm. No other areas of depigmentation were detected
                                                                         on total body examination (Figure 1, A and B). Dermoscopy
Halo phenomenon consists in an area of depigmentation                    revealed central whitish and blue areas on a homogeneous
around a skin lesion. It represents a benign regression phe-             pink-red background and polymorphous vascular pattern
nomenon most associated with acquired nevi [1]. Very rarely,             characterized by arborizing, hairpin and linear irregular ves-
a hypopigmented halo can also occur around melanomas                     sels, mainly arranged at the periphery. No pigment network
(halo melanoma, HM). Dermoscopy may help to distinguish                  was detected (Figure 1, C and D). Histology showed achro-
them from common halo nevi (HN).                                         mic atypical melanocytes aggregated in the dermis, without
                                                                         epidermotropism (Figure 2A). A perilesional lymphocytic
                                                                         infiltration with fibrosis at the periphery of the nodule was
Case presentation
                                                                         observed. Immunohistochemical analysis was positive for
We report the case of a 63-year-old man with a nodular, amel-            melanocytic markers but did not show basal melanocytes in
anotic lesion on the back surrounded by an achromic halo.                the area of epidermidis surrounding the nodule (Figure 2B).
The patient reported that the lesion occurred 1 year before,             Total-body positron emission tomography scan results were
with a progressive increase in size during the last 5 months.            unremarkable. The diagnosis of dermal melanoma was fi-
The lesion had become itchy, developing a vitiligo-like halo.            nally made (Breslow thickness 2.4 mm, non-ulcerated).
Physical examination showed a symmetrical, reddish nodule,               Wider local excision and sentinel node biopsies were neg-
8 mm in diameter, surrounded by a whitish area of about                  ative. The patient was disease free at 12 months follow-up.




Research Letter | Dermatol Pract Concept. 2022;12(3):e2022109                                                                          1
            Figure 1. (A) Clinical overview of the patient. (B) Naked-eye appearance of amelanotic halo melanoma as a
            reddish papule surrounded by an achromic halo. (C) Dermoscopy showed central whitish and blue areas on
            a homogeneous pink-red background and polymorphous vascular pattern. (D) Close-up of dermoscopic view.




               Figure 2. (A) Dermal proliferation of atypical achromic melanocytes with nodular dermal expansion and
               collarette formation at the periphery (H&E, 4x). (B) Immunohistochemistry supports the melanocytic
               phenotype and emphasizes the lack of junctional melanocytes in the epidermis straddling the collarette
               (HMB45 immunostaining with hematoxylin counterstain, 4x).




Conclusions                                                         HN and HM appear as a melanocytic lesion surrounded
                                                                    by a rim of white halo. The main distinguishing clinical
HN occurs in about 1% of the general population while HM            feature is that the shape of the achromic halo tends to be
is rarer, with only few cases reported in literature [1]. Both      more asymmetric in HM compared to HN [1]. HM also


2                                                                       Research Letter | Dermatol Pract Concept. 2022;12(3):e2022109
seems to occur at older age. There are only a few reports          HM is the most worrisome differential diagnosis of HN.
dealing with dermoscopy of HM, characterized by mela-           In most cases, dermoscopy may provide useful additional in-
noma-specific multicomponent patterns with atypical pig-        formation to clinical assessment, especially about the vascu-
mented network, irregular dots/globules, streaks, blotches,     lar pattern. However surgical excision and histopathological
blue-white veil and atypical vascular structures [2].           examination are mandatory especially in case of achromic
In our patient the absence of the pigmentary network and        nodular lesion like in our patient.
the polymorphous vessels in asymmetric arrangement did
not allow to rule out cutaneous melanoma metastasis, even
                                                                References
if hypopigmented peripheral halo has been very rarely re-
ported in such cases [1]. Histology did not highlight pri-       1. Nedelcu RI, Zurac SA, Brînzea A, et al. Morphological features
mary melanoma criteria, as ulceration, intraepidermal               of melanocytic tumors with depigmented halo: review of the lit-
                                                                    erature and personal results. Rom J Morphol Embryol. 2015;56
component, presence of associated nevus or regression.
                                                                    (2 Suppl):659-663. PMID: 26429156.
However, the absence of primitive melanoma in another
                                                                 2. Conforti C, Zelin E, Dri A, et al. Hypomelanotic halo melanoma:
site, as revealed by instrumental exams, led us to conclude         dermoscopic findings. Ital J Dermatol Venerol. 2021;156(3):408-
for the diagnosis of primary dermal melanoma with peri-             409. DOI: 10.23736/S0392-0488.20.06727-9. PMID: 33084271.
tumoral achromic halo.




Research Letter | Dermatol Pract Concept. 2022;12(3):e2022109                                                                    3
