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Cellular Blue Nevus With Satellitosis: A Possible Diagnostic Pitfall

Piana, Simonetta MD*; Grenzi, Laura†; Albertini, Giuseppe†

American Journal of Dermatopathology: June 2009 - Volume 31 - Issue 4 - pp 401-402
doi: 10.1097/DAD.0b013e318199039d
Letter to the Editor

*Department of Pathology Arcispedale Santa Maria Nuova Reggio Emilia, Italy †Department of Dermatology Arcispedale Santa Maria Nuova Reggio Emilia, Italy

To the Editor:

Although the diagnosis of common and cellular blue nevi is generally straightforward, in some cases, clinical characteristics are very worrisome and a superficial spreading malignant melanoma is expected. Very few cases of common blue nevus with satellites have been reported so far1-3; to our knowledge, this is the first description of satellitosis around a cellular blue nevus.

A 32-year-old woman presented with an asymptomatic, 10-mm, bluish papular lesion on her scalp that had been noticed since childhood and that recently enlarged. On clinical examination, it was dome shaped, with a smooth surface, and it was surrounded by 4 small bluish macules (Fig. 1). The main papule was excised with the clinical suspect of melanoma.

On histology, the papule was symmetric (Fig. 2) and it was constituted by a nodular dermal proliferation of ovoid melanocytes, with monomorphous nuclei and inconspicuous cytoplasm, intermingled with dendritic pigmented melanocytes (Fig. 3). Mitoses were absent. A superficial subepidermal grenz zone was present. At the lateral edges of the papule, there was an ill-defined proliferation of pigmented dendritic melanocytes, scattered among collagen fibers.

At immunohistochemistry, either the ovoid or the dendritic cells were positive with S-100 protein and MART-1/MELAN-A antibodies. A histological diagnosis of cellular blue nevus with satellitosis was then rendered.

Scalp is a classical site of cellular blue nevus that shares many features with common blue nevus4,5; it is different, however, mainly because of the architecture and the prevalence of ovoid cells that show a solid pattern of growth. Usually, a common blue nevus can be found at the periphery of the lesion; in our case, common blue nevus is present in multiple foci, which macroscopically appear as satellites. Indeed, the macroscopic features of the lesion are much more worrisome than the histological picture, and the clinical differential diagnosis with a melanoma may be impossible; as a consequence, a surgical excision is almost always unavoidable and the discrepancy between clinical suspect and histological features is expected.

Simonetta Piana, MD

Department of Pathology

Arcispedale Santa Maria Nuova

Reggio Emilia, Italy

Laura Grenzi, MD

Giuseppe Albertini, MD

Department of Dermatology

Arcispedale Santa Maria Nuova

Reggio Emilia, Italy

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© 2009 Lippincott Williams & Wilkins, Inc.