Melanoma arising in a hairy nevus spilus

Abstract

Cutaneous melanoma may develop de novo on normal skin or in contiguity with a potential melanocytic precursor. We report a 45-year-old man who presented with a recently developed nodule in a previously stable congenital nevus. Physical examination revealed a 10x18-cm lesion with speckled lentiginous pigmentation and terminal hairs on the lower back. A 2x2-cm suspicious nodule in the lesion was noted by the patient 2 months earlier. Histopathological evaluation of the nevus and the suspicious nodule revealed the characteristics of a melanocytic nevus and melanoma, respectively. It was interesting for the authors to observe terminal hairs in a lesion that was clinically 'speckled lentiginous' in appearance. This case report is a reminder that there may be great variation in the clinical appearance of nevus spilus, and thus dermatologists must be aware of these lesions as potential precursors of malignant melanoma.

Report of 27 cases of naevus spilus in 2134 patients with melanoma: is naevus spilus a risk marker of cutaneous melanoma?

“…Malignant melanoma has been reported as a very rare complication, but a renewed interest in this entity has occurred following the report, in the last 5 years, of 12 cases of malignant melanoma in NS previously considered as benign naevus, besides the previous 19 case reports of malignant melanoma on NS since the 1970s 1–10 …”

Hairy Nevus Spilus: A Case Series

“…To our knowledge, seven cases of nevus spilus with hypertrichosis have been reported in the English literature, albeit in different series. Two of them were in nevi developing malignant melanomas [One case had hair over an intradermal nevus within the nevus spilus (3), and the other had coarse hair all over the nevus (4)]. One case has been reported in association with phakomatosis pigmentokeratotica (nevus spilus with papules giving rise to coarse hair) (6).…”

“…The clinical relevance of hypertrichosis in nevus spilus is also unknown but does fit with the concept proposed by Schaffer et al that nevus spilus are part of the spectrum of CMN (7). Previously, two cases of hairy nevus spilus have been mentioned in lesions that developed malignant melanomas (3,4). The occurrence of melanomas in nevus spilus is rare.…”

“…The more pigmented smaller macules or papules are lentigines or melanocytic nevi, and the background diffuse pigmentation is a lentigo or a Cafe au lait macule (1,2). Although classically not mentioned as a “hairy nevus,” nevus spilus has occasionally been described as having overlying hypertrichosis (3–7). We now report four cases of nevus spilus with overlying coarse terminal hairs that arose mainly from the background pigmented area.…”

Nevus Spilus and Melanoma: Case Report and Review of the Literature

“…43 Since then, several cases have been described. 44,,,,,,,,,,,,,,,,–62 Melanoma in NS usually arises in Caucasian and black patients, on the trunk (64%) or limbs (36%), and has a female to male ratio of 56:44. The mean age of patients is 49 years (median 53 years; range 17–79 years).…”