Progression of Meyerson's naevus to Sutton's naevus

Eponyms, morphology, and pathogenesis of some less mentioned types of melanocytic nevi

Some types of melanocytic nevi are seldom mentioned in the literature and are therefore less well known. In the current study, we focus on the concepts of eponyms, synonyms, clinical presentation, and morphology of the following types: Meyerson nevus, cockarde (or cockade) nevus, Hori nevus, Sun nevus, Hidanos nevus, Duperrat nevus, Spark nevus, nevus spilus, eclipse nevus, Kerl nevus, and Kopf nevus.

[Disseminated perinaevic Meyerson phenomenon revealing melanoma]

BACKGROUND

Meyerson phenomenon (MP) consists of an eczematous reaction occurring around a pre-existing dermatologic lesion that is usually melanocytic and generally benign, and which is known as a Meyerson naevus. We report a case of multiple Meyerson naevi revealing melanoma, which itself was surrounded by a halo of eczema.

PATIENTS AND METHODS

A 55-year-old man of phototype III with atopic eczema presented for pruritic eczema present for a fortnight, found solely on and around the naevi on his trunk and at roots of his limbs. One of the melanocytic lesions affected by these Meyerson phenomena was clinically atypical and had been active for several years. Excision confirmed the diagnosis of level II extensive superficial melanoma measuring 0.75 mm in thickness and associated with lesional and perilesional eczematous remodelling. After surgery involving a 1-cm excision margin and local corticosteroid therapy of the eczema, the Meyerson phenomenon subsided with complete remission of the melanoma at 1 year.

DISCUSSION

Meyerson phenomenon can affect one or more naevi at the same time; it is generally transient, may recur on occasion, and has a favourable outcome either spontaneously or with corticosteroid treatment. When not removed for histological verification, the melanocytic lesion regains its initial appearance following resolution of the phenomenon. MP differs from Sutton phenomenon (SP), which is a perinaevic vitiligo reaction leading to complete or partial regression of the melanocytic lesion, which may be either benign or malignant.

CONCLUSION

This case of Meyerson phenomenon revealing melanoma shows that the melanocytic lesions targeted by MP are not necessarily benign.

Meyerson phenomenon in children: observation in five cases of congenital melanocytic nevi

To describe the characteristics of five pediatric patients with the Meyerson phenomenon associated with congenital melanocytic nevi, five cases were reviewed to retrieve information relating to clinical presentation, treatment and evolution of the eczematous phenomenon and of the nevi. Three of five patients were male. Mean age at presentation of the Meyerson phenomenon was 23 months (range: 4 mos-4 yrs). Three patients presented with only one halo eczematous lesion, while two patients presented with more then one halo eczematous lesions. The halo eczematous lesions were located on the leg, arm, and trunk in four, two, and two patients, respectively. All were associated with congenital melanocytic nevi with overlying hypertrichosis. Four were treated with topical corticosteroids, and five developed some degree of hypopigmentation within the nevic lesion. In children with Meyerson phenomenon associated with congenital hairy melanocytic nevi, neither trigger to the eczematous eruption nor preferential gender or anatomical site location was identified. The Meyerson phenomenon evolved towards hypopigmentation of the congenital melanocytic nevic lesions in all patients but no other cutaneous changes were observed on follow-up.

Halo dermatitis followed by the development of vitiligo associated with Sutton's nevi

Halo dermatitis (Meyerson's nevus) is an inflammatory, sometimes itchy, eczematous eruption usually encircling a preexisting melanocytic nevus that can be mistaken for malignant melanoma or Sutton's nevus. Unlike the latter, it mostly resolves spontaneously within weeks and never causes regression of the central lesion. Sutton's nevi, however, are frequently found in otherwise healthy individuals and patients suffering from vitiligo or malignant melanoma. The simultaneous appearance of Sutton's nevus and halo dermatitis has been reported before. However, the causes of both diseases remain unclear. We report a 16-year-old female who developed vitiligo and Sutton's nevi 6 months after a halo dermatitis lesion was excised. The coincidence of these disorders suggests common or similar immunological mechanisms induced by pigment cells and/or their components.

Unusual inflammatory and hyperkeratotic halo naevus in children

Although the classic halo naevus (HN) is a melanocytic naevus with a surrounding rim of depigmentation, these naevi can present unusual features. We describe an unusual and previously unreported variety of HN in children. Between March 1999 and September 2002, 14 children (11 boys and three girls, age range 6-14 years) were referred to us for evaluation of one or more 'inflamed' naevi. All the affected naevi showed the same clinical development: (i) after an initial inflammatory stage their surfaces gradually became thickened and rough, then (ii) verrucous and raised, and finally (iii) scaly crusted. A marked halo of depigmentation subsequently developed in all lesions, with simultaneous disappearance of the hyperkeratotic surface appearance. Lesions were multiple in five cases and single in nine, and were mainly located on the back (nine cases). Excisional biopsy was performed in eight cases. The biopsies were all taken in the 'prehalo phase'. In each case, histopathology revealed a compound melanocytic naevus, with additional features that varied depending on the clinical stage of the lesion. Immunohistochemical staining of the dense inflammatory infiltrate showed a predominance of CD3(+)/CD8(+) T lymphocytes, as usually occurs in HN. On the basis of these observations, we believe that the described naevi represent an unusual variety of HN in children. Knowledge of this possible clinical evolution of HN is important to avoid unnecessary surgical excision in these young patients.