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A Hypothesis on the Morphologic Differences Between Unna and Miescher Nevi on the Head and Neck, Based on Embryologic Bases

Fernandez-Flores, Angel MD, PhD*; Sanchez-Velicia, Laura MD; Manjon, Juan A. MD; Alija, Antonio MD; Soto, Francisco MD

The American Journal of Dermatopathology: August 2012 - Volume 34 - Issue 6 - p 602–606
doi: 10.1097/DAD.0b013e31823d8b80
Original Study

Abstract: Unna and Miescher nevi show very different morphologic features. The main difference is that melanocytes involve mainly the papillary dermis in Unna nevi, whereas they widely penetrate the reticular dermis in Miescher nevi. The reason for this behavior is not totally understood, but anatomical location might play a role, since because Unna nevi are mainly found on the trunk, whereas Miescher nevi are mainly found on the face. We decided to test this hypothesis in relative easy way: dermis from the frontal, temporal, maxillary, and mandibullary regions derives from the neural crest, whereas the dermis of the parietal/occipital regions originates from the paraxial mesoderm (somites and somitomeres). Therefore, we studied the morphology of 137 acquired melanocytic nevi from the head and neck and classified their locations in 7 areas: occipital, temporal, parietal, frontal, face, high neck, and low neck. From such areas, we distinguished 4 groups: area A (parietal + occipital + low neck); area B (face + temporal + frontal + high neck); area 1 (parietal and occipital); and area 2 (temporal and frontal). In region A, 97.30% of the nevi were of Unna type. In region B, 89.00% were of Miescher type. Region A had 76.60% of Unna type nevi, whereas region B had 98.89% of Miescher nevi. In area 1, 100% of the nevi were of Miescher type. In area 2, 86.67% of the nevi were of Unna type. Region 1 had 86.67% of the cranial Unna nevi, whereas region 2 had 100% of the cranial Miescher nevi. Moreover, 90.9% of the nevi from the low neck were of Unna type. In the high neck, 20% of nevi were of Unna type. Finally, 90.90% of Unna nevi were in the low neck, whereas 80% of Miescher nevi were in the high neck. We concluded that these findings supported the hypothesis that the embryologic differences of these areas of head and neck might play a role in the morphology of Unna and Miescher nevi.

Departments of *Pathology

Dermatology, Hospital El Bierzo, Ponferrada, Spain.

Reprints: Angel Fernandez-Flores, MD, PhD, Department of Pathology, Hospital El Bierzo, Calle Medicos sin Fronteras 7, Ponferrada 24400, Spain (e-mail:

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.