Cellular blue nevi of the eyelid: A possible diagnostic pitfall

Appropriate classification of melanocytic lesions in the eyelid region is important to avoid unnecessary surgery. Here we report 3 cases of cellular blue nevi in the lower eyelid, and make recommendations about approaching these challenging lesions. In each case, a diagnosis of cellular blue nevus was made using the following features: low mitotic rate, absence of necrosis, low Ki-67 reactivity, and mostly uniform HMB45 labeling. Furthermore, in each case there was either a prior diagnosis of melanoma or features worrisome for an atypical melanocytic lesion. For melanocytic lesions of the eyelid with histologic features suggestive of cellular blue nevus, the correct diagnosis may mean a more conservative surgical resection and less likelihood of ocular tissue sacrifice and disfigurement.