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Persistent and recurrent blue nevi.

J D Harvell¹, W L White

¹Department of Pathology, Stanford University Medical Center, California, USA.

The American Journal of Dermatopathology

|December 23, 1999

Summary

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Blue nevi can persist and recur after biopsy, sometimes showing atypical features that mimic malignancy but are often benign. Awareness of this phenomenon is crucial for accurate diagnosis and prognosis.

Area of Science:

Dermatopathology
Oncology
Histopathology

Background:

Persistence and recurrence of common melanocytic nevi are well-documented.
In contrast, the persistence of blue nevi is infrequently reported, necessitating further characterization.

Observation:

Nine cases of biologically persistent and clinically recurrent blue nevi were analyzed.
Recurrent lesions exhibited various histiotypes, including spindle-fascicular, biphasic dendritic-sclerotic/spindle-fascicular, and dendritic-sclerotic blue nevi.
Some recurrences showed atypical histologic features, such as increased cellularity and pleomorphism, initially raising concerns for malignancy.

Findings:

Blue nevi of all histiotypes can persist and recur, with a longer interval to recurrence compared to common melanocytic nevi.

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Histologically, persistent blue nevi often reveal a deeper spindle-fascicular component not apparent in initial superficial biopsies.

Despite atypical features in some recurrences, long-term follow-up supported benign biologic behavior, suggesting these changes can be reactive or 'pseudomalignant'.

Implications:

Clinical recurrence of blue nevi, even with atypical features, does not always indicate malignant transformation.
Understanding the potential for benign but atypical-appearing recurrences is vital to prevent diagnostic and prognostic errors.
This study highlights the importance of careful histopathologic evaluation and clinical correlation in managing recurrent blue nevi.