Blue nevus

Blue nevus (also known as blue nevomelanocytic nevus and nevus bleu) is a type of melanocytic nevus characterized by its distinct blue color. This coloration is due to the melanin pigment being deeper in the dermis, rather than in the epidermis, making the nevus appear blue due to the Tyndall effect. Blue nevi are generally benign, but on rare occasions, they can evolve into a melanoma, a type of skin cancer.

Etiology and Pathogenesis

The exact cause of blue nevi is not well understood, but they are believed to arise from the proliferation of melanocytes (pigment-producing cells) deep within the dermis. Unlike most nevi, which are located in the epidermis or at the epidermal-dermal junction, the melanocytes in blue nevi are found deeper in the skin. This positioning, combined with the scattering of light as it passes through the skin, results in the characteristic blue color.

Clinical Features

Blue nevi are typically small, round, and have a smooth surface. They can range in color from blue to blue-black or even gray. The size usually does not exceed a few millimeters in diameter, but larger lesions are possible. These nevi are most commonly found on the limbs, particularly the hands and feet, but can also appear on the face, buttocks, and sacral area.

Diagnosis

Diagnosis of a blue nevus is primarily clinical, based on its distinctive appearance. However, if there is any doubt or concern about the nature of the lesion, a dermatoscopy or a skin biopsy may be performed. Dermatoscopy can help differentiate a blue nevus from other pigmented lesions, while a biopsy and subsequent histological examination can confirm the diagnosis and rule out malignancy.

Treatment and Management

In most cases, blue nevi do not require treatment as they are benign and asymptomatic. However, if a blue nevus shows signs of change in size, shape, color, or becomes symptomatic (itching, bleeding), it should be evaluated by a dermatologist. Surgical removal may be recommended in these cases to exclude melanoma. Regular monitoring of the lesion is advised for individuals with blue nevi, especially if there is a personal or family history of melanoma.

Prognosis

The prognosis for individuals with blue nevi is generally excellent, as these lesions are benign. However, there is a very low risk of transformation into melanoma. Therefore, awareness and monitoring of any changes in the nevus are important.

Epidemiology

Blue nevi are relatively uncommon and can occur in individuals of any age, but they are more frequently observed in adolescents and young adults. There is no significant gender predilection, and they can affect all skin types, although they may be less noticeable on darker skin.

See Also

• Melanocytic nevus
• Melanoma
• Dermoscopy
• Tyndall effect