In vivo reflectance confocal microscopy of halo nevi

Abstract

Halo nevi named also Sutton's nevi are benign melanocytic lesions occurring especially among adolescents. Halo nevus was first described in the 16th century as a benign, rapidly changing melanocytic lesion with a whitish halo around preexisting nevus. In 1916, Sutton used the term "leukoderma acquisitum centrifugum" for the first time. The incidence of halo nevi in the entire population is about 1%, with no predilection for gender or race. 1 The majority of patients have multiple halo lesions, which are usually located on the back.Clinical examination often shows a disturbing white ring surrounding the nevus. Some authors indicate a familial tendency for halo nevi, or coexistence with atopic dermatitis and autoimmune disorders.Clinically, halo nevi are important "melanoma simulators," which usually appear in children and young adults. Besides, halo phenomenon can arise in atypical nevi, in nonmelanocytic tumors, inflammatory lesions, but also in melanoma. Whitish halo surrounding nevi can be clinically and dermoscopically difficult to distinguish from regression in melanoma. 2,3 It could be notably challenging when "halo" is slightly visible or asymmetric. Reflectance confocal microscopy in

Reflectance confocal microscopy in paediatric patients: Applications and limits

“…Sutton's nevi may also represent a pitfall showing cytologic and architectural atypia in confocal microscopy, due to inflammation and regression 11,12 . In our series, two of the atypical melanocytic lesions were Sutton's nevi.…”

“…Sutton's nevi may also represent a pitfall showing cytologic and architectural atypia in confocal microscopy, due to inflammation and regression. 11,12 In our series, two of the atypical melanocytic lesions were Sutton's nevi. RCM imaging was indeed helpful in one of the two cases, the lesion was not well demarcated; however, a regular ringed and clod pattern was detected at the DEJ together with melanophages in the dermis (Figure 2).…”

Sutton’s naevi as a pitfall for reflectance confocal microscopy: marked inflamed naevi could not be suitable for teleconfocal examination

“…BRAF mutations, particularly p.(Val600Glu), are frequently identified in melanoma and other human cancers. 5 We report clinical presentations of three patients with postzygotic BRAF mutations in affected skin, identified by next-generation sequencing (NGS).…”

“…The evaluation of Sutton's naevi poses a diagnostic challenge since they can present with both atypical dermoscopic and confocal findings. 5,6 Indeed, the most robust confocal features usually associated with melanoma 7 such as intraepidermal pagetoid dendritic and roundish cells, architectural disarrangement with non-edged papilla and atypical nucleated cells at the dermis can be found in some Sutton's naevi 6 (Fig. 1).…”

“…In addition, some groups, including ours, have recently published the confocal findings of such equivocal Sutton's naevi. 5,6 We aimed to evaluate the RCM diagnostic accuracy of confocal experts when it comes to distinguishing between inflamed naevi and melanomas. In order to study this, we retrospectively reviewed confocal findings of 20 cases of inflamed tumours: 5 thin melanomas with regression features on histopathology, 5 banal naevi and 10 histologically proven Sutton's naevi.…”