MALIGNANT BLUE NEVUS

By Gary M. White, MD

Malignant Blue Nevus


The term "malignant blue nevus" (MBN) refers to a rare and heterogeneous group of melanomas that arise in two clinical settings:

  1. Melanomas arising in association with a common or cellular blue nevus.
  2. Melanomas arising de novo and resembling cellular blue nevi histologically.

Clinical

For the melanomas arising from a pre-existing blue nevus, the typical story is that of a sudden change in a previously stable blue papule or plaque. For MBN arising de novo, the typical clinical scenario is a progressively enlarging or multinodular blue-black lesion. The most common site in many reports is the head and neck (especially the scalp), even though blue nevi most commonly occur on the dorsum of the hands and feet.

In one review of 23 cases [Cancer. 2009 Jul 1;115(13):2949-55], the median age was 44 years, and men comprised 65% of the patients.

Treatment

MBN should be treated in the same way as any other melanoma variants based on clinical staging and pathologic prognostic indices [Cancer. 2009 Jul 1;115(13):2949-55]. See treatment of melanoma.

Additional Pictures

This lesion appeared over 2 months on this middle-aged woman's knee. Biopsy showed blue nevus with severe atypia.
Malignant Blue Nevus Malignant Blue Nevus

References

A 50-year-old man presented with a 3 year history of bluish black macules on the upper lip. Ann Dermatol. 2010 Feb; 22(1): 119–124.

A 77-year-old man with a progressive blue pigmentation of his forehead and temples. The differential includes a malignant blue nevus vs. melanoma. Dermopedia.org

A 17-month-old girl presented for evaluation of a 15 × 20-cm blue-gray plaque of the scalp that had grown commensurately with the child since birth. Giant Congenital Sclerosing Blue Nevus of the Scalp Presenting with Rapidly Disseminated Fatal Metastases in a Pediatric Patient. Plast Reconstr Surg Glob Open. 2016 Feb; 4(2): e627

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