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Melanoma arising in association with blue nevus: a clinical and pathologic study of 24 cases and comprehensive review of the literature

Mod Pathol. 2014 Apr 18. doi: 10.1038/modpathol.2014.62.

Loghavi S1, Curry JL1, Torres-Cabala CA1, Ivan D1, Patel KP2, Mehrotra M2, Bassett R3, Prieto VG1, Tetzlaff MT1.

Author information

  • 1Department of Pathology, Section of Dermatopathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
  • 2Department of Hematopathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
  • 3Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.

Abstract

Melanomas arising in association with blue nevi or mimicking cellular blue nevi comprise a relatively rare and heterogeneous group of melanomas. It remains controversial which prognostic indicators predictive of outcome in conventional cutaneous melanomas are applicable to this type of melanoma. Here, we describe the clinical and histopathologic features of 24 melanomas arising in association with blue nevi and correlate these with clinical outcome. The mean patient age was 49 years (range: 23-85) with a slight female predominance (15 females:9 males). The most common anatomic locations included the head and neck region (50%), the trunk (21%), and the buttock/sacrococcygeum (17%). Histologically, the tumors were typically situated in the mid to deep dermis with variable involvement of the subcutis, but uniformly lacked a prominent intraepithelial component. The mean tumor thickness (defined as either the standard Breslow thickness or, if not available due to the lack of orientation or lack of epidermis, the largest tumor dimension) was 20.9?mm (range: 0.6-130?mm). The mean mitotic figure count was 6.5/mm2(range: 1-30/mm2). Perineural invasion was common (38%). Follow-up was available for 21 cases (median 2.1 years). The median overall survival, recurrence-free survival, time to local recurrence, and time to distant recurrence were 5.2, 0.7, 2.6, and 1.6 years, respectively. Logistic regression analyses demonstrated a significant association between tumor thickness and recurrence-free survival (hazard ratio=1.02 per mm; P=0.04) and reduced time to distant metastasis (hazard ratio=1.03 per mm; P=0.02) with a similar trend toward reduced time to local recurrence (hazard ratio=1.02 per mm; P=0.07). No other parameters (age, anatomic location, mitotic figures, lymphovascular or perineural invasion, or type of associated blue nevus) emerged as significant. In addition, we provide a comprehensive review of 109 cases of melanoma blue nevus type described in the English literature and summarize our findings in this context.Modern Pathology advance online publication, 18 April 2014; doi:10.1038/modpathol.2014.62

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