Halo Nevus - an overview (2022)

Halo nevi (Sutton nevi) are caused by a cell-mediated inflammatory response directed against nested nevo­melanocytes and adjacent junctional epidermal melanocytes.

From: Urgent Care Dermatology: Symptom-Based Diagnosis, 2018

Nevi

Rick D. Kellerman MD, in Conn's Current Therapy 2021, 2021

Halo (Melanocytic) Nevi

Halo (melanocytic) nevi are melanocytic nevi in which a white rim or halo has developed. This phenomenon most commonly occurs around compound or intradermal nevi and is histologically associated with a dense, bandlike inflammatory infiltrate. The white halo area is histologically characterized by diminished or absent melanocytes and melanin. Approximately 20% of patients with halo nevi also exhibit vitiligo.

Although a halo can develop around many lesions in the skin, the most important differential diagnosis is between a halo nevus and melanoma with a halo. The halo and the central melanocytic proliferation of halo nevi are symmetrical, round or oval, and sharply demarcated. Halo nevi most commonly occur in adolescence as an isolated event, but approximately 25% to 50% of affected persons have two or more.

The clinical course of halo nevi is variable. With time, the halo can repigment while the central nevus persists. Alternatively, the melanocytic nevus can regress completely and leave a depigmented macule that can persist or repigment over months or years.

Halo nevi do not require surgical excision unless atypical clinical features suggest the possibility of an atypical melanocytic lesion. It is advisable (particularly in adults, in whom halo nevi are less common) to perform a complete cutaneous examination with and without the aid of a Wood’s lamp to rule out any associated atypical pigmented or regressed lesions. All patients should be advised to use sunscreens or protective clothing because of the increased risk of sunburn in the depigmented halo region.

Nevi and Malignant Melanoma

James G.H. Dinulos MD, in Habif's Clinical Dermatology, 2021

Halo Nevi.

A compound or dermal nevus that develops a white border is called a halo nevus. The incidence in the population is estimated to be 1%. Halo nevi are found most commonly in children. The average age of onset is 15 years. Halo nevi typically persist for a decade or longer. The depigmented halo is symmetric and round or oval with a sharply demarcated border (Fig. 22.24). There are no melanocytes in the halo area. Halo nevi have the dermoscopic features of benign MNs, with globular and/or homogeneous patterns that are typically observed in children and young adults. Halo nevi structural patterns remain unchanged over time. Patients with Turner syndrome (short stature, gonadal dysgenesis, webbed neck, cubitus valgus, and lymphedema at birth) have a halo nevus prevalence of 18%.4

Benign skin tumors

Donna Marie Vleugels, James E. Sligh, in General Dermatology, 2009

Clinical presentation

Halo nevus (Figure 15-10) is a nevomelanocytic nevus surrounded by a symmetric halo of macular depigmentation with sharply defined borders. Its development often indicates the beginning of regression of the central nevus. Halo nevi are most commonly found on the posterior trunk in teenagers, and multiple lesions may occur simultaneously. Halo nevi typically develop in several stages. First, a halo arises around a pre-existing nevus over the course of several months. The nevus then regresses over months to years and is followed by repigmentation of the halo. Halo nevi are associated with vitiligo, and depigmentation may rarely develop around a primary malignant melanoma.

(Video) Halo nevus by Dr. Iris Zalaudek

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Lentigines, nevi, and melanomas

James W. Patterson MD, FACP, FAAD, in Weedon's Skin Pathology, 2021

Halo Nevus

A halo nevus is characterized by the presence of a depigmented halo up to several millimeters in width around a melanocytic nevus. This change is most often an idiopathic phenomenon that precedes the lymphocytic destruction of the nevus cells and the clinical regression of the lesion.388,389 Note that the lymphocyte-mediated regression of a nevus can take place without the development of a clinical halo.390 Conversely, the clinical halo phenomenon may not be accompanied by inflammation on histological examination. Halo change may involve one or several nevi. Halo nevi of the choroid are described in the ophthalmology literature.391 Very rarely, a halo may develop around a congenital melanocytic nevus or a nodular melanoma.392–397 Another rare phenomenon is the development of a targetoid halo.398 This may consist of an annular pigmented ring with a central pale brown to grayish zone.399 The “golden brown halo” found on dermoscopy of a Miescher nevus400 and thecockarde nevus may be related phenomena. Familial cases have been reported.401 Halo nevi also occur in Turner syndrome. A putative halo nevus susceptibility gene is located close to the HLA-C locus.402 Localized leukotrichia was also present in one case.403

An unusual inflammatory and hyperkeratotic variant of halo nevus has been reported in 14 children, from Bologna, Italy.404 All nevi showed the same clinical development. After an initial inflammatory stage, their surfaces gradually became thickened and rough, then verrucous and raised, and finally scaly and crusted. A marked halo of depigmentation subsequently developed in all lesions, with simultaneous disappearance of the hyperkeratotic surface.404 The histology was typical of a halo nevus with variable epidermal hyperplasia.404 Another unusual variant is the pseudo–halo nevus produced by the application of sunscreen to a nevus and its immediate surroundings.405

Circulating antibodies that react against melanoma cells have been found in a high proportion of individuals with halo nevi, as have circulating lymphocytes with an activated phenotype,406 suggesting that both humoral and cell-mediated immunity are involved in the rejection of nevus cells and the formation of the halo.397

The halo nevus must be distinguished from the Meyerson nevus, in which there is an eczematous halo surrounding a nevus.

Halo nevi exhibit the characteristic dermoscopic features of benign melanocytic nevi, represented by globular and/or homogeneous patterns.407 There is considerable size reduction of the nevus component with time.407

Choroidal Nevi

David A. Lewis, Daniel M. Albert, in Retina (Fifth Edition), 2013

Nevus

The term “nevus” in its historical context, is synonymous with hamartoma and denotes any congenital tumor-like tissue malformation.3 However, except in a few cases (e.g., nevus sebaceous or nevus flammeus), this word is now used restrictively to designate benign acquired or congenital tumors of neural crest-derived cells, including atypical melanocytes.2,3 A melanocyte is a mature melanin-producing and melanin-containing cell.2,3 Melanocytes derive embryologically from melanoblasts.2,4 These cells migrate during closure of the neural tube, and melanization starts between the 24th and 27th weeks of gestation, proceeding anteriorly until birth.4 Nevus cells are believed to be modified, or atypical, melanocytes.3 Zimmerman2 has emphasized that the morphologic appearance of cutaneous nevus cells may vary considerably, making it difficult to characterize a typical nevus cell.

(Video) Halo Nevus - Daily Do's of Dermatology

Halo nevus

Halo nevus is a rarely encountered subgroup of choroidal nevus, and it is named after the depigmented annulus that surrounds the central pigmented portion of the nevus. It is believed that the halo is composed of large, polygonal cells with foamy cytoplasm, termed balloon nevus cells, similar to those found in halo nevi in other anatomic locations.5

Giant choroidal nevus

There are no definitive criteria to designate which nevus falls under the category of “giant” choroidal nevus; however, Shields etal.6 included those with a basal diameter greater than or equal to 10mm. Based on their size, this rare subgroup of choroidal nevi may be particularly difficult to distinguish from malignant melanoma.6

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Cutaneous Tumors and Tumor Syndromes

Amy S. Paller MD, Anthony J. Mancini MD, in Hurwitz Clinical Pediatric Dermatology (Fourth Edition), 2011

Halo Nevus

A halo nevus is a unique skin lesion in which a centrally placed, usually pigmented nevus becomes surrounded by a 1–5mm halo of hypo- or depigmentation (Fig. 9.23). These lesions are common in children and young adults. The cause of the spontaneous loss of pigmentation is unknown but appears to be related to an immunologic destruction of melanocytes and nevus cells.90,91 Adding support to this hypothesis is the fact that several patients with halo nevi have a tendency toward the development of vitiligo (see Ch. 11). Histologic examination of halo nevi reveals reduction or absence of melanin and a dense inflammatory infiltrate around the central nevus. Although compound or intradermal nevi are the tumors most frequently associated with the halo phenomenon, it may also occur around blue nevi, Spitz nevi, neurofibromas, melanomas, and metastatic lesions of melanoma. Giant congenital melanocytic nevi may also reveal the halo phenomenon with pigment regression and, at times, self-destruction.92,93

Typical halo nevi are notable for loss of pigmentation in the nevus, with a pink appearance and, frequently, eventual disappearance of the original melanocytic lesion. Occasionally, darkening of the central nevus may occur.94 Halo nevi may appear on almost any cutaneous surface, but the site of predilection for most lesions is the trunk, particularly the back. In most patients, eventual repigmentation of the halo occurs over a period of months to years.

Halo nevi tend to be benign, although the halo phenomenon may occur around lesions revealing varying degrees of histologic atypia.95 Potential concern has been raised over reports of malignant melanoma exhibiting the halo phenomenon, and the increased incidence of halo nevi in adults with melanoma.96 In a survey of pediatric dermatologists, no diagnoses of malignant melanoma in pediatric patients with halo nevi were noted.96 Clinical features that may suggest an increased probability of an atypical melanocytic lesion within a halo include the ‘ABCDE’ diagnostic criteria of melanoma (Table 9.2) and asymmetry or irregularity of the surrounding depigmentation. Any patient with a halo nevus, and especially if multiple halo lesions are present, should receive a complete skin and mucous membrane examination to assess for melanocytic lesions revealing atypical features. Patients with the halo nevus phenomenon, concomitant vitiligo and ocular melanoma have been described,97 but in general, ophthalmologic evaluation is not indicated. If the melanocytic lesion in the central portion of a halo reveals concerning or atypical features, complete excision should be performed. If, on the other hand, the central lesion has benign characteristics, excision is unnecessary and the lesion may be observed at intervals until it has resolved.

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Cutaneous Tumors and Tumor Syndromes

Amy S. Paller MD, Anthony J. Mancini MD, in Hurwitz Clinical Pediatric Dermatology (Fifth Edition), 2016

(Video) Halo or Sutton Nevus by Dr. R. Hofmann

Halo Nevus

A halo nevus is a unique skin lesion in which a centrally placed, usually pigmented nevus becomes surrounded by a 1- to 5-mm halo of hypopigmentation or depigmentation (Fig. 9-26). These lesions are common in children and young adults. The cause of the spontaneous loss of pigmentation is unknown but appears to be related to an immunologic destruction of melanocytes and nevus cells.129,130 Adding support to this hypothesis is the fact that several patients with halo nevi have a tendency toward the development of vitiligo (see Chapter 11; Fig. 9-27). Histologic examination of halo nevi reveals reduction or absence of melanin and a dense inflammatory infiltrate around the central nevus. Although compound or intradermal nevi are the tumors most commonly associated with the halo phenomenon, it may also occur around blue nevi, Spitz nevi, neurofibromas, melanomas, and metastatic lesions of melanoma. Giant CMN may also reveal the halo phenomenon with pigment regression and at times, self-destruction.131,132

Typical halo nevi are notable for loss of pigmentation in the nevus, with a pink appearance and commonly, eventual disappearance of the original melanocytic lesion. Occasionally, darkening of the central nevus may occur.133 Halo nevi may appear on almost any cutaneous surface, but the site of predilection for most lesions is the trunk, particularly the back. In most patients, eventual repigmentation of the halo occurs over a period of months to years.

Halo nevi tend to be benign, although the halo phenomenon may occur around lesions revealing varying degrees of histologic atypia.134 Potential concern has been raised over reports of MM exhibiting the halo phenomenon and the increased incidence of halo nevi in adults with melanoma.135 In a survey of pediatric dermatologists, no diagnoses of MM in pediatric patients with halo nevi were noted.135 Clinical features that may suggest an increased probability of an atypical melanocytic lesion within a halo include the ABCDE diagnostic criteria of melanoma (see Table 9-1) and asymmetry or irregularity of the surrounding depigmentation. Any patient with a halo nevus, especially if multiple halo lesions are present, should receive a complete skin and mucous membrane examination to assess for melanocytic lesions revealing atypical features. Patients with the halo nevus phenomenon, concomitant vitiligo, and ocular melanoma have been described,136 but in general ophthalmologic evaluation is not routinely indicated. If the melanocytic lesion in the central portion of a halo reveals concerning or atypical features, complete excision should be performed. If, on the other hand, the central lesion has benign characteristics, excision is unnecessary and the lesion may be observed at intervals until it has resolved.

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Hypopigmentation Disorders

Yuin-Chew Chan, Yong-Kwang Tay, in Neonatal Dermatology (Second Edition), 2008

Congenital Halo Nevi

Cutaneous Findings

A halo nevus is a benign melanocytic nevus (usually a compound nevus) surrounded by a ring of depigmentation. Depigmented zones around nevi have also been reported with congenital nevi,202,203 Spitz nevi, blue nevi, neurofibroma, and primary or metastatic malignant melanoma.204

Halo nevi are often multiple, usually occur on the trunk, and appear most commonly in young people. Vitiligo is often associated and develops at distant sites.203 The condition is usually not inherited, although familial cases have been described.205 The nevus tends to flatten and may eventually involute over a period of months, leaving an area of depigmentation that persists for several years, but which eventually may repigment.

Etiology/Pathogenesis

The nevus cells appear to be destroyed by cytotoxic CD8+ T lymphocytes recognizing class 1 HLA antigens on their surfaces.206 This theory of an immunologic mechanism is supported by the fact that a lymphocytic infiltrate is seen around the nevus cells and the nevus cells show cytotoxic changes.207 Unlike acquired halo nevi, congenital halo nevi may have an absence of inflammation on histology and may not involute.202,203

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Pigmented Lesions

James E. Fitzpatrick MD, ... W. Lamar Kyle MD, in Urgent Care Dermatology: Symptom-Based Diagnosis, 2018

Halo Nevus

ICD10 code D23.9

BENIGN NEOPLASIA

Pathogenesis

Halo nevi (Sutton nevi) are caused by a cell-mediated inflammatory response directed against nested nevo­melanocytes and adjacent junctional epidermal melanocytes. Microscopic examination of a halo nevus reveals a dense infiltrate of lymphocytes surrounding these nests, with a loss of melanocytes at the dermoepidermal junction in the clinically depigmented areas. Research completed by two of the authors (JEF, WAH) showed that normal acquired melanocytic nevi are “immunologically invisible” and do not express human leukocyte antigen (HLA) markers that trigger a host response. For reasons unknown, these same HLA markers are expressed in halo nevi, and this engenders an immunologic response in the host. Patients with vitiligo are more likely to develop halo nevi.

Clinical Features

Halo nevi usually develop in children and adolescents, although adults may also develop them. There is no predilection for sex or ethnic background.

Halo nevi are most common on the back (Fig. 31.16).

Halo nevi usually develop in acquired melanocytic nevi and may be solitary or multiple.

Early halo nevi consists of skin-colored, tan, or brown papules (Fig. 31.17), with a sharply demarcated area that is depigmented (white skin).

Mature halo nevi demonstrate loss of the central nevus and replacement with a discrete, round to oval area of depigmentation (white skin).

Diagnosis

The clinical presentation is usually diagnostic of a halo nevus, but other melanocytic lesions (e.g., blue nevi, congenital nevi [Fig. 31.18], atypical nevi, melanoma) may also demonstrate a halo.

In exceptional cases, particularly in older persons, a biopsy should be performed to establish the diagnosis firmly and to exclude a malignant melanocytic neoplasm with an inflammatory host response.

Adults who present with halo nevi should have a complete cutaneous examination, because in rare cases, halo nevi may be associated with melanoma at other sites. An eye examination, to exclude ocular melanoma, should be recommended.

Treatment

In classic cases no treatment is necessary and is the preferred management in children and adolescents.

Atypical-appearing halo nevi can be surgically removed. The biopsy only needs to include the central papule and not the entire halo.

Clinical Course

Halo nevi usually resolve over a period of months to a year, although some rare cases may demonstrate a halo that persists for more than a decade. Some cases demonstrate a recurrence of the nevus that incited the halo phenomenon.

(Video) 5- Halo nevus

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FAQs

Should I worry about halo nevus? ›

Halo nevi are usually benign. No treatment is necessary if they have a typical appearance, other than reassuring the patient that they are not a concern for skin cancer.

Should halo nevus be removed? ›

Background: Halo nevus (HN) is a rare dermatologic disorder characterized by typical whitish rim surrounding an existing melanocytic nevus resembling halo. It is a cosmetic problem that may be linked to vitiligo, and it is advised to remove these nevi in order to avoid development of vitiligo.

How long does it take for a halo nevus to go away? ›

Observations have showed that the halo nevi last for 10 years or more, but a large subgroup passes through various stages to finally regress completely. The process takes approximately 8 years on average.

Is a halo nevus cancerous? ›

A halo nevus is a mole surrounded by a white ring or halo. These moles are almost always benign, meaning they aren't cancerous. Halo nevi (the plural of nevus) are sometimes called Sutton nevi or leukoderma acquisitum centrifugum.

Videos

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