Ann Dermatol.  2010 Feb;22(1):119-124. 10.5021/ad.2010.22.1.119.

A Malignant Melanoma Associated with a Blue Nevus of the Lip

• Lee HY
• Na SY
• Son YM
• Kang HK
• Baek JO
• Lee JR
• Roh JY

• KMID: 2172056
• DOI: http://doi.org/10.5021/ad.2010.22.1.119

Abstract

Blue nevi are characterized by a collection of pigment-producing melanocytes in the dermis. These lesions clinically present as well demarcated cerulean-blue or bluish black colored papules or plaques that usually measure less than 1 cm in diameter. They are typically found on the dorsal surface of the hands and feet or in the head and neck region; however, they are rarely found in the oral cavity. These lesions are usually benign and stable over time. However, malignant melanomas developing in or associated with a blue nevus (which is also called malignant blue nevus) have been only rarely reported. A malignant blue nevus might develop in a common blue or cellular blue nevus, a giant congenital nevus or in a nevus of Ota, or it may be malignant from the start. Malignant blue nevi most commonly are found on the scalp. A malignant blue nevus of the lip has not been previously reported in the medical literature. We report here on a patient with a malignant melanoma associated with a blue nevus of the lip. The malignant melanoma was presumed to have developed from a blue nevus that was present on the upper lip of a 50-year-old male.

Keyword

Blue nevus; Malignant blue nevus; Malignant melanoma; Upper lip

MeSH Terms

Dermis
Foot
Hand
Head
Humans
Lip
Male
Melanocytes
Melanoma
Middle Aged
Mouth
Neck
Nevus
Nevus of Ota
Nevus, Blue
Scalp

Figure

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  Fig. 1 (A) Bluish black macules (arrow head) with irregular borders and (B) ulcerative nodules (arrow) localized on the upper lip with the development of satellite lesions.

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  Fig. 2 The histopathological findings of the bluish black macule showed pigmented spindle-shaped and dendritic melanocytes among thickened collagen bundles from the reticular dermis which were close to the epidermis (H&E, ×100).

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  Fig. 3 (A) The histopathologic findings of the bluish black ulcerative nodule showed atypical epithelioid tumor cells and scattered dark pigmented spindle-shaped cells in the dermis. The findings shown include (B) pleomorphic epothelioid tumor cells intermingled with pigmented spindle shaped cells, and (C) necrotic tumor cells (arrow) and mitosis (arrow head). (D) Focal atypical large melanocytes were arranged as single cells on the basal layer of the epidermis without pagetoid spread. The immunohistochemical stains were positive for HMB45 (E) and S-100 (F) (A: H&E, ×100, B: H&E, ×200, C: H&E, ×400, D: H&E, ×200, E: HMB45, ABC method, ×200, F: S-100, ABC method, ×200).

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  Fig. 4 CD117 (c-kit) staining of the blue nevus (from the bluish black macule) (A) showed strong positivity and (B) there was a decreased c-kit expression on the deep invasive part of the malignant blue nevus (from the ulcerative nodule) (A, B: CD 117 stain, ABC method, ×200).

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  Fig. 5 (A) Atypical dark pigmented tumor cells have infiltrated the lymph node. (B) The infiltrated tumor cells in the lymph node showed a strong c-kit expression (A: H&E, ×100, B: CD 117 stain, ×200).

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