10.5826/dpc.1301a59
text/xml
2160-9381
2601
en
Caterina Longo
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Diving Into the Blue: A Case of Melanoma Arising in a Giant Congenital Blue Nevus During Pregnancy
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-01-31
2022-05-18
2023-01-31
2023-03-01
e2023059
Dermatol Pract Concept
Caterina Longo
2023/01/31
10.5826/dpc.1301a59
e2023059
Department of Dermatology, University of Modena and Reggio Emilia; Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy 
2160-9381
en
e2023059
Ribero S, Longo C, Dika E, et al. Pregnancy and melanoma: a European-wide survey to assess current management and a critical literature overview. J Eur Acad Dermatol Venereol. 2017;31(1):65-69. DOI: 10.1111/jdv.13722. PMID: 27231086.
Diving Into the Blue: A Case of Melanoma Arising in a Giant Congenital Blue Nevus During Pregnancy
https://dpcj.org/index.php/dpc/article/download/2601/1917
Diving Into the Blue: A Case of Melanoma Arising in
 a Giant Congenital Blue Nevus During Pregnancy
         Alex Curti1, Simonetta Piana2, Maria Banzi3, Fabio Castagnetti4, Michela Lai1,5,6,
                                        Caterina Longo1,5


1 Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
2 Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
3 Medical Oncology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
4 Breast Surgery Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
5 Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
6 Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy



Citation: Curti A, Piana S, Banzi M, Castagnetti F, Lai M, Longo C. Diving Into The Blue: A Case Of Melanoma Arising In A Giant
Congenital Blue Nevus During Pregnancy. Dermatol Pract Concept. 2023;13(1):e2023059. DOI: https://doi.org/10.5826/dpc.1301a59
Accepted: August 23, 2022; Published: January 2023
Copyright: ©2023 Curti et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial 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: Caterina Longo, Centro Oncologico ad Alta Tecnologia Diagnostica - Dermatologia, Azienda Unità Sanitaria
Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy. Department of Dermatology, University of Modena and Reggio Emilia, Italy.
Phone: +390522295611 E-mail: longo.caterina@gmail.com




Case Presentation                                                        analysis, the melanoma showed no alterations in BRAF,
                                                                         c-Kit and all RAS. GNAQ and GNA11 mutation state
Melanoma is the most frequent malignancy in pregnancy,                   was not evaluated since it is not part of our standard of
accounting for 31% of malignant tumors diagnosed during                  care panel.
gestation [1].                                                                After the induction of delivery at the 38th week of gesta-
    We report a case of a 28-year-old woman, pregnant at                 tion, histological examination of the placenta ruled out pos-
the 34th week of gestation, who had periodical skin check                sible secondarism to the fetus.
examination for the presence of a congenital blue nevus                       A total body CT scan of the patient identified four solid
involving the neck, the scalp and the preauricular region                lesions in the liver, histologically confirmed as metastasis. Fi-
(Figure 1A). During pregnancy, she self-reported the devel-              nal diagnosis of stage IV melanoma was made.
opment of a solid subcutaneous 4.2 cm firm mass on her                        After a multidisciplinary discussion of the case, immuno-
right latero-cervical region (inset).                                    therapy with nivolumab was started at a dosage of 240 mg
    Histological examination was consistent with mela-                   iv every two weeks.
noma developed on a congenital melanocytic blue nevus                         After one year of systemic treatment, the patient achieved
(Figure 1B). The marked melanocytic atypia and the high                  a complete response and since the response is still main-
mitotic count allowed the differential diagnosis with a                  tained after four years follow up, immunotherapy has now
proliferative nodule in congenital nevi. At the molecular                been discontinued.


Image Letter | Dermatol Pract Concept. 2023;13(1):e2023059                                                                              1
Figure 1. (A) Clinical picture of a giant congenital blue nevus, involving the right latero-cervical region and extending to preauricular skin
and to the scalp; (inset) clinical picture showing a firm solid mass, developed during pregnancy on the right latero-cervical region on con-
genital blue nevus. (B) Skin and soft tissue biopsy specimen showing intensely pigmented fusiform proliferation of melanocytes with mitotic
figures and necrosis, finding consistent with melanoma.



Teaching Point                                                           References
European guidelines for the management of melanoma                        1. Kyrgidis A, Lallas A, Moscarella E, Longo C, Alfano R, Ar-
                                                                             genziano G. Does pregnancy influence melanoma prognosis?
during pregnancy are still lacking, hence it is extremely
                                                                             A meta-analysis. Melanoma Res. 2017;27(4):289–299. DOI:
challenging to decide the correct diagnostic and therapeu-
                                                                             10.1097/CMR.0000000000000334. PMID: 28430756.
tic approach to adopt. A multidisciplinary management is                  2. Ribero S, Longo C, Dika E, et al. Pregnancy and melanoma:
warranted and each case must be discussed on an individual                   a European-wide survey to assess current management and
patient-tailored basis [2].                                                  a critical literature overview. J Eur Acad Dermatol Venereol.
                                                                             2017;31(1):65-69. DOI: 10.1111/jdv.13722. PMID: 27231086.




2                                                                               Image Letter | Dermatol Pract Concept. 2023;13(1):e2023059
