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On-line version ISSN 1806-4841
An. Bras. Dermatol. vol.85 no.5 Rio de Janeiro Sept./Oct. 2010
Clinical, dermoscopic and histopathological evaluation of the Meyerson nevus - case report*
Tatiana Villas Boas GabbiI; Erick D. OmarII; Paulo R. CriadoIII; Neusa Y. S. ValenteIV; José Eduardo C. MartinsV
ISpecialist, assistant doctor of the Dermatological Division of the University Hospital of the Faculty of Medicine of the University of São Paulo (HC-FMUSP) - São Paulo (SP), Brazil
IIEx-resident of the Dermatological Division of the University Hospital of the Faculty of Medicine of the University of São Paulo (HC-FMUSP) - São Paulo (SP), Brazil
IIISupervisor- doctor of the Dermatological Division of the University Hospital of the Faculty of Medicine of the University of São Paulo (HC-FMUSP) - São Paulo (SP), Brazil
IVResearcher of the Laboratory of Medical Investigation 53 University Hospital of the Faculty of Medicine of the University of São Paulo (HC-FMUSP) - São Paulo (SP), Brazil
VFull professor of the Dermatological Division of the University Hospital of the Faculty of Medicine of the University of São Paulo (HC-FMUSP) - São Paulo (SP), Brazil
Meyerson nevi occur whenever a rare focal and transitory eczematous eruption arises around melanocytic lesions. The same phenomenon has also been observed in non-melanocytic lesions as well. Herein we report the case of a 25 year old, male patient, who had noticed, two months before, the arising of a pruriginous and erithematous halo around two nevi localized on his abdomen. The lesions were found to be atypical on dermoscopic examination and he was submitted to surgical excision of both nevi. Histopathological examination revealed displastic compound melanocytic nevi, surrounded by intraepidermical vesicles and spongiosis. Present report suggests that Meyerson phenomenon does not seem to alter dermoscopic features of nevi.
Keywords: Dermoscopy; Nevus; Nevus, pigmented
In 1971, Meyerson described two patients that presented erythema, desquamation and pruritus concerning exclusively nevi, localized on the trunk and close extremities and that improved after therapeutics with topic corticosteroids.1 Since then, this phenomenon has been described in various pigmented lesions including junctional nevi , Sutton nevi, atypical nevi 2 and congenital ones.3 It was even documented in non-melanocytic lesions such as basal cells carcinomas, spinocellular carcinomas, seborrheic keratosis, keloids, histiocytofibromas and insect bites.4 We report here the case of a young patient that clinically presented two Meyerson nevi which made it possible for us to document the dermatoscopic and histopathological findings of this rare phenomenon.
Male patient, hygienic, aged 25, white, sought the dermatologic service of our hospital complaining of eruption he had noticed two months before, in two nevi situated on his abdomen (Picture 1A). Apart from that, the patient did not present other complaints or comorbidities and denied the use of medication. It was observed, in his dermatological examination, two brownish papulous lesions situated on his abdominal region surrounded by a halo of erythema and edema topped by crusts. (Picture 1A).There were a few other common nevi distributed along the whole body which had been preserved. Dermatoscopy suggested the diagnosis of atypical melanocytic lesion in the two cases (Pictures 1B and 2). One nevus (Picture 2) presented asymmetry in two axes, four different colours and the presence of amorphous areas and peripheral globules, leading to a score (TDS) of 5.3, according to the ABCD rule, described by Stolz et al.5 The other lesion presented a similar aspect and a combination of patterns: globular in the centre and reticular in the periphery, with discreet asymmetry and presence of more than one (Picture 1B). Surgical excision was carried out in the two nevi. The histopathological examination confirmed the dermatoscopic findings and revealed melanocytic nevi, with epidermical vesicles and spongiosis around them and in the epidermical component of the nevi. (Pictures 3 and 4). There were nests of melanocytes in dermo-epidermic junction and in the superior dermis apart from bridges of melanocytes between epithelial crystals and fibroplsia in the papillary dermis (Picture 3). Enlargement made it possible to visualize some atypical malanocytes. The nevi were diagnosed as atypical compound nevi with associated spongiotic dermatitis (Picture 4).
The physiopathology involved in this case remains unknown. Hypothesis such as pityriasis rosea restricted to the neus 1, solar exposition, subacute allergic dermatitis and immunological reaction3 were suggested. Our patient denied solar exposition or allergies. The phenomenon of Meyerson tends to affect young adults, without associated disesases, as it seems to be the case of our patient.
The clinical aspects of the Meyerson nevus are of a pruriginous, symmetric and eczematous halo that appears around a pigmented lesion. An asymmetric halo was also described in the medical literature2. Recently, Longo and collaborators6 published a case of atypical Meyerson nevus that did not present clear signs of eczema although the patient complained of light pruridus in the site. Compound eczema may or may not be cured after treatment with topic corticosteroids creams. Clarifying of the eczema after the excision of the nevus only was also described.7 Contrary to the Sutton nevus, the Meyerson nevus persists after the resolution of the halo of eczema.3
Histopathology shows a nevus, generally compound, with associated dermatitis.3 In this present case, the two nevi that were excised were compound nevi.
The inflammation of the eczema might be seen as hypopigmented areas and of cicatricial aspect in dermatoscopy.2,6 In the same article previously mentioned,6 Longo and collaborators opted by the surgical removal of a Meyerson nevus based on dermatoscopy that had revealed a suspicious lesion : hypopigmented multifocal areas and areas of regression, with some sparse brownish marks
The present report suggests that the phenomenon of Meyerson does not modify the dermatoscopic characteristics of the nevi. Our patient had a surgery due to a strong suspicion of atypical nevi based on the findings of dermatoscopic exam, fact that was lately confirmed by histopathology.
We thank Doctor Gustavo Alonso Pereira, -a fellow doctor of the Ambulatory Service of Tumours - HCFMUSP, for the analysis and description of the dermatoscopic exam of the lesions presented in this work.
1. Meyerson LB. A peculiar papulosquamous eruption involving pigmented nevi. Arch Dermatol. 1971; 103:510-2. [ Links ]
2. Elenitsas R, Halpern AC. Eczematous halo reaction in atypical nevi. J Am Acad Dermatol. 1996; 34:357-61. [ Links ]
3. Kus S, Ince U, Candan I, Gurunluoglu R. Meyerson phenomenon associated with dysplastic compound nevi. J Eur Acad Dermatol Venereol. 2006; 20:350-1. [ Links ]
4. Tegner E, Björnberg A, Jonsson N. Halo dermatitis around tumours. Acta Derm Venereol. 1990;70:31-4. [ Links ]
5. Braun RP, Rabinovitz HS, Oliviero M, Kopf AW, Saurat JH. Dermoscopy of pigmented skin lesions. J Am Acad Dermatol. 2005; 52:10-21. [ Links ]
6. Longo C, Segura S, Cesinaro AM, Bassoli S, Seidenari S, Pellacani G. An atypical Meyerson's naevus: a dermoscopic, confocal microscopic and immunohisto chemical description of one case. J Eur Acad Dermatol Venereol. 2007; 21:414-6. [ Links ]
7. Cox NH, Bloxham CA, Lawrence CM. Halo eczema: resolution after excision of the central naevus alone. Clin Exp Dermatol. 1991; 16:66-7. [ Links ]
Mailing address: Received on 09.04.2008. * Trabalho realizado na Divisão de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP) - São Paulo (SP), Brasil.
Tatiana Villas Boas Gabbi
Divisão de Clínica Dermatológica do Hospital das Clínicas da FMUSP
Av. Enéas de Carvalho Aguiar, 255- 3º. andar
05403-000 São Paulo - SP, Brazil
Phone/Fax 11 5044 1008 / 3237 2419
Approved by the Advisory Board and accepted for publication on 30.04.2010.
Conflict of interest: None
Financial funding: None
Received on 09.04.2008.
* Trabalho realizado na Divisão de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP) - São Paulo (SP), Brasil.