Case and Research Letters
Nevus Spilus Associated With Agminated Blue Nevus: A Rare Combination
Nevo spilus asociado a nevus azul agminado: una combinación infrecuente
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Ayala, M.D. Ramón, M. Cabezas, E. Jordá" "autores" => array:4 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Ayala" "email" => array:1 [ 0 => "dayalca83@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.D." "apellidos" => "Ramón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Cabezas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Jordá" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nevo <span class="elsevierStyleItalic">spilus</span> asociado a nevus azul agminado: una combinación infrecuente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 686 "Ancho" => 975 "Tamanyo" => 224334 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathology revealed a combined lesion, with findings characteristic of a blue nevus (a dermal proliferation of spindle-shaped melanocytes associated with melanophages) and findings corresponding to nevus spilus (a lentiginous proliferation of melanocytes at the dermoepidermal junction and nests of melanocytes with no atypia in the superficial dermis). Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>x10.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">To the Editor:</span></p><p id="par0010" class="elsevierStylePara elsevierViewall">Nevus spilus, also known as speckled lentiginous nevus or zosteriform lentiginous nevus, is a melanocytic lesion that presents as a light-brown circumscribed background macule or patch that contains numerous more darkly pigmented macules or papules within its borders. Histologically, the background macule is due to lentiginous melanocyte hyperplasia at the dermoepidermal junction, while the more intensely pigmented lesions are melanocytic junctional nevi or combined nevi. Nevus spilus can be congenital but is more commonly an acquired lesion; it has a benign behavior, though a few cases of melanoma arising on a nevus spilus have been reported.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Blue nevi are bluish-colored lesions formed by an intradermal proliferation of melanocytes. They usually present as a single, acquired lesion, but very rarely can arise as multiple lesions grouped in a well-defined area, not usually larger than 10<span class="elsevierStyleHsp" style=""></span>cm in diameter; they are then called agminated blue nevi.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> The combination of agminated blue nevi and nevus spilus is rare.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A 79-year-old woman was seen for an asymptomatic pigmented lesion that had been present on the posterior surface of her right lower leg since birth (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Physical examination revealed a 10<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>cm plaque formed of a light-brown macule that contained numerous dark-brown papules and bluish lenticular lesions within its borders. Dermoscopy of the brownish papules showed a globular melanocytic pattern, while the bluish papules presented a homogeneous blue pattern (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Histology of the different biopsies taken from the pigmented plaque revealed a lesion with a combined pattern (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). A proliferation of spindle-shaped melanocytes with no atypia was observed in the dermis, accompanied by melanophages, a characteristic finding in blue nevus. Melanocyte proliferation with a lentiginous pattern was also seen at the dermoepidermal junction; this correlated clinically with the background light-brown macule. Finally, a third component formed of nests of melanocytes with correct maturation and with no architectural atypia was observed in the superficial dermis. These nests produced the dark-brown macules and papules of the nevus spilus.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The definitive diagnosis was nevus spilus associated with agminated blue nevi. The patient stated that the nevus spilus had been present since birth, whereas the bluish lesions had appeared progressively throughout her life, with a significant increase in the number of blue nevi in recent years.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Blue nevus usually arises as a solitary lesion, although it can rarely occur in clusters in an agminated pattern.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> Nevus spilus can be associated with blue nevus, with common melanocytic nevus, or with Spitz nevus. The association of nevus spilus and agminated blue nevi is a rare combination, with few cases reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,5</span></a> Kawamura<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> presented a case and defined 3 histologic variants of this entity: type <span class="elsevierStyleSmallCaps">I</span>, a combination of blue nevus and cellular nevus; type <span class="elsevierStyleSmallCaps">II</span>, a combination of blue nevus with nevus spilus; and type <span class="elsevierStyleSmallCaps">III</span>, a combination of blue nevus and fibromatous or myomatous nevoid formation. There is controversy regarding the cause of the association. Some authors consider that this is a random phenomenon,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> while others believe that nevus spilus provides a favorable environment for the growth of other nevi.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> The risk of malignant change is low in nevus spilus, although cases of melanoma arising on this pigmented lesion have been reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6–8</span></a> Our case presents the rare combination of nevus spilus with agminated blue nevi and, despite the clinical and dermoscopic diagnosis, it was necessary to perform several biopsies of the pigmented plaque to exclude a diagnosis of melanoma.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We have presented a case of Kawamura type <span class="elsevierStyleSmallCaps">II</span> blue nevus, highlighting the need to perform periodic clinical control of pigmented lesions and suggesting the possibility of monitoring this type of lesion using digital dermoscopy.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ayala D. Nevo <span class="elsevierStyleItalic">spilus</span> asociado a nevus azul agminado: una combinación infrecuente. Actas Dermosifiliogr. 2016;107:614–616.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 465 "Ancho" => 1500 "Tamanyo" => 138709 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pigmented lesion measuring 10<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>cm on the posterior surface of the right lower leg. The lesion was formed of a background of a light-brown macule that contained multiple dark-brown macules and papules within its borders, together with various bluish lenticular elements.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 941 "Ancho" => 975 "Tamanyo" => 124173 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy image showing the collision of a blue nevus (presenting a homogeneous blue pattern) with several melanocytic nevi (showing a typical globular pattern).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 686 "Ancho" => 975 "Tamanyo" => 224334 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathology revealed a combined lesion, with findings characteristic of a blue nevus (a dermal proliferation of spindle-shaped melanocytes associated with melanophages) and findings corresponding to nevus spilus (a lentiginous proliferation of melanocytes at the dermoepidermal junction and nests of melanocytes with no atypia in the superficial dermis). 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 13 | 6 | 19 |
| 2024 Octubre | 158 | 47 | 205 |
| 2024 Septiembre | 175 | 39 | 214 |
| 2024 Agosto | 195 | 60 | 255 |
| 2024 Julio | 192 | 51 | 243 |
| 2024 Junio | 176 | 51 | 227 |
| 2024 Mayo | 154 | 42 | 196 |
| 2024 Abril | 123 | 24 | 147 |
| 2024 Marzo | 126 | 41 | 167 |
| 2024 Febrero | 139 | 54 | 193 |
| 2024 Enero | 92 | 38 | 130 |
| 2023 Diciembre | 108 | 31 | 139 |
| 2023 Noviembre | 118 | 26 | 144 |
| 2023 Octubre | 122 | 42 | 164 |
| 2023 Septiembre | 122 | 39 | 161 |
| 2023 Agosto | 116 | 26 | 142 |
| 2023 Julio | 138 | 62 | 200 |
| 2023 Junio | 103 | 40 | 143 |
| 2023 Mayo | 132 | 53 | 185 |
| 2023 Abril | 75 | 64 | 139 |
| 2023 Marzo | 89 | 57 | 146 |
| 2023 Febrero | 68 | 34 | 102 |
| 2023 Enero | 56 | 47 | 103 |
| 2022 Diciembre | 83 | 47 | 130 |
| 2022 Noviembre | 71 | 31 | 102 |
| 2022 Octubre | 89 | 24 | 113 |
| 2022 Septiembre | 68 | 34 | 102 |
| 2022 Agosto | 72 | 37 | 109 |
| 2022 Julio | 71 | 40 | 111 |
| 2022 Junio | 56 | 31 | 87 |
| 2022 Mayo | 143 | 57 | 200 |
| 2022 Abril | 187 | 47 | 234 |
| 2022 Marzo | 178 | 45 | 223 |
| 2022 Febrero | 159 | 28 | 187 |
| 2022 Enero | 191 | 38 | 229 |
| 2021 Diciembre | 141 | 45 | 186 |
| 2021 Noviembre | 129 | 50 | 179 |
| 2021 Octubre | 141 | 52 | 193 |
| 2021 Septiembre | 110 | 49 | 159 |
| 2021 Agosto | 125 | 46 | 171 |
| 2021 Julio | 98 | 30 | 128 |
| 2021 Junio | 127 | 43 | 170 |
| 2021 Mayo | 118 | 70 | 188 |
| 2021 Abril | 241 | 98 | 339 |
| 2021 Marzo | 120 | 38 | 158 |
| 2021 Febrero | 101 | 37 | 138 |
| 2021 Enero | 47 | 15 | 62 |
| 2020 Diciembre | 78 | 18 | 96 |
| 2020 Noviembre | 74 | 17 | 91 |
| 2020 Octubre | 46 | 8 | 54 |
| 2020 Septiembre | 55 | 18 | 73 |
| 2020 Agosto | 45 | 23 | 68 |
| 2020 Julio | 52 | 21 | 73 |
| 2020 Junio | 63 | 31 | 94 |
| 2020 Mayo | 38 | 36 | 74 |
| 2020 Abril | 31 | 24 | 55 |
| 2020 Marzo | 38 | 22 | 60 |
| 2020 Febrero | 3 | 1 | 4 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 4 | 0 | 4 |
| 2019 Abril | 2 | 6 | 8 |
| 2019 Marzo | 2 | 0 | 2 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Febrero | 36 | 5 | 41 |
| 2018 Enero | 55 | 12 | 67 |
| 2017 Diciembre | 62 | 9 | 71 |
| 2017 Noviembre | 38 | 6 | 44 |
| 2017 Octubre | 51 | 11 | 62 |
| 2017 Septiembre | 23 | 6 | 29 |
| 2017 Agosto | 61 | 11 | 72 |
| 2017 Julio | 53 | 12 | 65 |
| 2017 Junio | 56 | 8 | 64 |
| 2017 Mayo | 42 | 12 | 54 |
| 2017 Abril | 45 | 17 | 62 |
| 2017 Marzo | 34 | 6 | 40 |
| 2017 Febrero | 104 | 7 | 111 |
| 2017 Enero | 31 | 11 | 42 |
| 2016 Diciembre | 39 | 17 | 56 |
| 2016 Noviembre | 24 | 16 | 40 |
| 2016 Octubre | 20 | 19 | 39 |
| 2016 Julio | 1 | 1 | 2 |
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