By Gary M. White, MD
This mole is almost gone, leaving just the halo.
The halo nevus is a mole surrounded by a white oval or circle. The white halo results from the immune system attacking and removing melanin from the mole and the surrounding skin.
- It is common in children for the immune system to attack normal, benign nevi including a cm or so margin of normal skin. Over time, melanin is lost and a white halo surrounds the nevus. Ultimately over several years, the central mole may be completely eradicated.
- In older adults, a melanoma may develop a halo (see halo melanoma) and thus great care should be take in this population. One key tipoff is the halo of a halo melanoma tends to be irregular compared to the smooth, round or oval halo of a halo nevus.
- For other conditions with a halo, see halo.
- Patients with vitiligo may have one or more halo nevi. In one study of 208 children with vitiligo [Ped Derm 2016;33;44], 55 (26%) had at least one halo nevus. In that study, the presence of a halo nevus does not significantly alter the risk of disease progression or response to treatment.
- Conversely, approximately 20% of patients with halo nevi also have vitiligo, either involving the nevus or at a distant site.
- See also nevus.
A completely depigmented circle of skin centered around a pigmented lesion in a child is typical. Multiple lesions are common. This author has had one patient with 35 halo nevi at one time!! Halo giant congenital nevi may occur [JAAD 1988;19:954–960].
A complete skin examination should be done for all patients.
It is always important to evaluate the central mole for signs of atypia, e.g. using the ABCD's as with any other mole. If the central lesion is clinically atypical, it should be removed. In children however, most are benign and no treatment is needed. In contrast, most halo nevi in older adults should be removed as the possibility of melanoma is more likely.
Halo congenital nevi.
Halo nevus in a darker-skinned patient. Indian J Paediatr Dermatol 2015;16:23-8
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