Moles (Nevi)

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Spitz Nevus

The Spitz nevus (also known as "spindle cell nevus") is a benign, acquired mole derived from melanocytes (pigment cells). In the past, this condition was a cause for concern because it often was confused with melanoma. Today, Spitz nevi are believed to be benign and are managed more conservatively. This type of nevus generally occurs in children and adolescents, most often on the face and head.

Cause

It is presumed that Spitz nevi are derived from the same cells that cause common acquired moles. Heredity does not appear to play a role.

Signs and Symptoms

Spitz nevi usually have a smooth surface, a reddish-brown hue, and are commonly about 6 to 8 millimeters (mm) in diameter. They are typically solitary and most often appear between the ages of 3 and 13 years. Onset is typically quite rapid, usually stabilizing after a period of initial growth. The Spitz nevus may persist until adulthood or it may evolve into a common mole.

Diagnosis

Spitz nevi usually are suspected clinically when a child develops a reddish papule on the face. A biopsy usually is obtained in such cases. Many dermatologists recommend excision of a Spitz nevus completely, but conservatively. Recurrence is common with incompletely removed lesions, and they may be difficult to distinguish from melanoma on pathological evaluation. Some Spitz nevi regress on their own.

Prevention

There is no known way to prevent Spitz nevi.

Halo Nevus

Overview

A halo nevus is a lesion with a centrally placed nevus surrounded by a white halo of depigmented (loss of pigment) skin. It is most commonly seen in adolescence, but can be observed at any age. Over a period of months to years, the halo nevus gradually involutes and disappears, often leaving a residual white patch.

Cause

The trigger or cause of spontaneous pigment loss in a halo nevus is not known; however, pigment loss is the result of an immunologic process in which melanocytes are destroyed (pigment-producing cells). In essence, the body's immune cells attack other cells of the body.

Signs and Symptoms

This relatively common disorder occurs between the first and fifth decades of life, most frequently during late adolescence. Halo nevi can occur almost anywhere on the body, but most often appear on the trunk, especially the back. As many as 50% of affected individuals have more than one halo nevus.

The phenomenon seems to follow several stages. The first is a sudden appearance of the white halo around the mole. In the following months or years the central nevus disappears. Finally, the white patch may re-pigment spontaneously and return to normal skin color. However, the white area often remains.

Diagnosis

Because halo nevi are quite distinct in their presentation, diagnosis is obvious. Most halo nevi are seen with benign (noncancerous) moles. Rarely, this phenomenon is seen around a malignant melanoma. It is therefore important to examine the central mole. If it appears typical, it can be tracked and evaluated at regular intervals. If the central lesion appears atypical and suspicious, it should be removed and biopsied for microscopic evaluation.

Treatment

Halo nevi are considered harmless and self-limiting and are not treated. If the central lesion is problematic in appearance, however, removal of the mole with its surrounding halo is recommended.

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