Blue nevus: diagnosis by color. Blue nevus: why is the formation dangerous and should it be removed? Surgical removal of blue nevus

Synonym: blue proliferating nevus.

Definition... A type of blue nevus, characterized by its large size and the possibility of transformation into melanoma.

Historical reference... Cell blue nevus was first identified as a non-melanoma formation by A.S. Allen in 1949.

Age and gender... The nevus is congenital or appears during childhood. It is diagnosed, as a rule, in children and young people, but sometimes in elderly patients. The median age at diagnosis is 33 years. It is more often observed in females (the ratio of women to men is 2: 1).

Elements of the rash... The development of a nevus begins with the formation of a spot or induration in the dermis, which gradually transforms into a knot or plaque with a smooth or uneven surface, usually up to 2-2.5 cm in diameter. In some patients, there may be mild itching in the nevus area. Sometimes a nevus can be large (10 cm or more). Ulceration of the tumor is extremely rare.
The color is blue.

Localization... The location of the nevus can be any, but in almost 50% of cases it is located on the buttocks and in the lumbosacral region, less often on the back of the hands and feet. Rare tumor localizations are described: conjunctiva, scalp and meninges of the spinal cord.

a - Blue cellular nevus in the right buttock in a 20-year-old patient.
b - blue cell in the occipital region in a 19-year-old patient.

Histology... It is characterized by large size, usually occupies the entire thickness of the reticular layer of the dermis. It has, as a rule, a characteristic configuration in the form of an "hourglass" - it forms limited tumors in the dermis and subcutaneous tissue, connected by a narrow isthmus. The tumor consists of rather large spindle-shaped cells located in the deep parts of the dermis, forming bundles and eddies. The nuclei are juicy, oval or fusiform. The cells are grouped into cells, separated by connective tissue layers, in which there are clusters of macrophages with coarse granules of melanin. The content of melanin in the melanocytes themselves is variable, from negligible to abundant. On the periphery, pigmented melanocytes with long processes, indistinguishable from the cells of a common blue nevus, are found. It is believed that the presence of these cells is essential for the diagnosis of cellular blue nevus. The absence of borderline activity, epidermal invasion, inflammation and necrosis distinguishes the cellular blue nevus from melanoma, as well as the presence of a clear outline, unexpressed atypia of cells and a practical absence of mitosis.

Immunophenotype... An immunohistochemical study reveals a positive reaction to markers S-100, HMB-45, Bc1-2 and CD34.

Diagnosis set on the basis of clinical and histological signs, it is also necessary to conduct an immunohistochemical study. Difficulties arise in the interpretation of morphological data.

Differential diagnosis performed primarily with melanoma and malignant blue nevus ("blue" melanoma). Architectonically, the microscopic picture of a cellular blue nevus is close to "blue" melanoma, but with it, pronounced cellular atypia with numerous mitoses and fields of necrosis is determined. The following clinical observation testifies to the difficulty of diagnosis.

The patient first applied for a pigmented lesion on the right buttock when she was 20 years old. From birth, she had a bluish mass in this area, which over the past 6 months began to rapidly increase in size and acquired a blackish color. The tumor was excised, the macroscopic picture - a black-gray tumor measuring 1.5 x 2.5 cm, histology - melanoma, the level of invasion according to Clark V, tumor thickness - 2.5 cm.In addition, immunohistochemical and repeated histological studies were performed, which made it possible to establish definitive diagnosis of blue cell nevus.

Course and prognosis... Currently, depending on the clinical picture, pathomorphological signs, course and prognosis of the tumor process, two forms of blue cellular nevus are distinguished: typical (classical) and atypical with undefined biological potential.

The latter, according to its characteristics, occupies an intermediate position between the typical form of the tumor and malignant blue nevus(or melanoma, which has arisen against the background of a blue cellular nevus). There is a simultaneous defeat of different tissues. A case of localization of a nevus in the scalp area with lesions of the skin, soft tissues, bones and dura mater in a patient at birth is described. Cases of the development of melanoma against the background of a cellular blue nevus are described.

Malignant transformation occurs, as a rule, after a long period of time (years) and in persons of mature or old age and is manifested by a rapid increase in the tumor, its ulceration and discoloration. Cases of a pigmented variant of a cellular blue nevus have been described. With a cellular blue nevus, cells similar to this skin formation can be observed in the regional lymph nodes. This process is called "benign metastasis" by some authors.

These changes in the lymph nodes simulate melanoma metastases, which requires careful differential diagnosis between these processes.

One of the most unusual moles that ordinary people have to deal with is a blue nevus; what it is, how to deal with such a neoplasm, not everyone understands. For this reason, it makes sense to understand its features and determine the actual actions when such a mole appears.

The main differences

There are a number of signs by which you can understand that you have to deal with a blue nevus:

it has clear boundaries;
the form of education can be in the form of an hourglass, oval or round;
the structure is homogeneous, dense, there is no hair on it;
sizes can vary from a few millimeters to 3 cm;
color largely depends on the amount of pigment and the depth at which the neoplasm is located.

A blue nevus is most often a non-dangerous form of a mole, although the risk of rebirth remains

Important. Blue nevus is similar to other moles and age spots, so it is important to differentiate it from them. It is better to do this in the clinic, since there are all the necessary conditions for a full diagnosis.

As for similar manifestations, they occur in Dubreus' melanosis, giant pigmented nevus and borderline moles.

Diagnostics

In order to determine the specific type of nevus, the following diagnostic measures are used:

Dermatoscopy... It is carried out to study the depth of the neoplasm, its contours and structure.
Visual inspection of the mole.
Histological examination, allowing you to very accurately determine the type of nevus. It is carried out only after the completion of the excision process.
Ultrasound... It is necessary to study the infiltrative growth of education and its depth.
Siascopic examination... With its help, doctors determine the degree of distribution in the cells of the pigment, which forms the formation itself.

The traditional method of diagnosing a nevus is its excision and subsequent examination, but thanks to dermatoscopy, it is possible to determine the type of mole without intervention

Note. A blue nevus is visually noticeably different from other species, but a full diagnosis is still necessary to determine the depth and structure of the neoplasm.

Views

If we consider the clinical and morphological characteristics of a blue nevus, then three key types can be distinguished:

Cellular... The size of such a mole can vary from 1 to 3 cm. The surface itself is rough, and the shape resembles an hourglass. The color is most often dark blue. The external signs of such a nevus resemble melanoma. Most often, this type is fixed in the buttocks or lower back. Much less often, it forms on the back of the feet and hands.
Combined... This form of blue skin nevus differs in that it combines the signs of a standard and borderline mole, and sometimes even a complex segmental formation.
Simple... In this case, the size of the mole is limited to 1 cm, and its surface is smooth. The most common shape is round. The color can vary from dark blue to light gray. Moles of this form are found mainly in the neck, on the arms, face, and less often on the oral mucosa.

Note. A blue nevus can be either solitary or appear in many places on the body.

Potential risks

One of the first steps that must be taken when any mole appears is to determine how likely it is to degenerate into a malignant tumor. It is this fact that determines whether or not to remove the blue nevus.

But the good news is that this type of mole is extremely rare to degenerate into melanoma.

There are a number of signs by which you can independently identify the formation of a malignant formation:

blurred borders appear around the mole;
the size of the nevus changes, and quickly;
the structure also changes - tuberosity appears;
sputum becomes visible on the surface;
the integrity of the mole is violated;
painful sensations appear in the area of the neoplasm;
hair begins to grow on the surface;

One of the signs of the degeneration of a blue nevus into melanoma is a complete or partial change in its color

If such signs become noticeable, then there is every reason to suspect that the blue nevus is degenerating into a malignant formation. The surest thing to do in such a situation is to visit a doctor and undergo a full-fledged diagnosis.

It also makes sense to pay attention to factors that can increase the risk of rebirth:

constant mechanical stress (the mole is touched by various objects or clothing);
blue nevus appears in many places on the body:
hormonal imbalance and dysfunction of the immune system;
the formation of a nevus in the face;
traumatic effect on the stain.

Removal process

If the worst suspicions are confirmed, or the mole "behaves" in such a way that the likelihood of a tumor appearing is extremely high, then it is necessary to remove the blue nevus.

Using a laser is one of the safest and most accurate ways to remove a blue nevus, but surgical excision may be necessary in some cases

There are several ways to do this:

Laser use... The body of the mole is "evaporated" in layers. This method allows you to have an extremely accurate impact. As a result, the nevus is completely removed without any scars or cosmetic defects.
Radio wave method... Accurate and painless technique. With the help of a radio knife, you can also carry out a histological analysis for the presence of cancer cells.
Electrocoagulation... The areas around the mole and the neoplasm itself are affected by a powerful electric current. One session is enough to get the desired result.
Cryodestruction. In this case, liquid nitrogen is used to remove the blue nevus. Its effect leads to the destruction and subsequent rejection of the mole tissue.
Surgical excision. Here we are talking about the classic surgical intervention. This technique has one significant drawback: after the completion of the procedure, a scar remains.

Surgical excision is the most relevant way to remove a blue nevus if it has already begun to degenerate into a malignant tumor

Note. In most cases, surgical removal of a blue nevus is the most acceptable option to stop the degeneration process.

A blue mole is a formation that in most cases does not pose a threat. But at the same time, it can degenerate into a malignant tumor, regardless of the person's age. For this reason, a blue nevus should be monitored, and in case of any changes, consult a doctor.

Mole blue skin nevus: photo and removal, prognosis.

A birthmark located on the skin of a person has the term "nevus" in medical practice.

A nevus by its nature is a benign formation that occurs as a result of the movement of melanoblasts during the period of intrauterine development.

There are a lot of varieties of nevi and their classification occurs according to groups - melanoma-dangerous and non-dangerous.

It is to the first group that the emergence of such an education as a blue nevus, which has another name - the blue nevus of Jadassono-Tiche, is attributed.

Clinical manifestations of blue nevus

Blue nevi are not included in the risk group of any age category of people, but more often than in others, they appear during the period of hormonal changes in the adolescent's body.

Mole blue nevus photo

Since the appearance and growth of a blue nevus does not cause discomfort to a person, it is not always possible to immediately recognize its occurrence.

Its localization on the body is typical for the dorsum of the feet and hands, as well as the legs, buttocks, and forearms.

On the face, blue occurs extremely rarely.

This formation is usually oval in shape and visually similar to a nodule.

Its contours are clear, but the color of dark blue or light blue is uneven on the surface.

In size, a blue nevus does not exceed 1 cm, a rare exception is a 3-centimeter formation.

In such a case, the appearance of the spot may give rise to the feeling of a foreign body under the skin.

Causes of blue nevus

Until now, scientists have not clearly formulated the causes of a blue nevus, but the fact that this pigmented formation has an acquired character, and not congenital, is precisely established.

Perhaps the reasons for the appearance of this formation on the body are the same factors as the usual birthmark:

hormonal changes in the body (adolescence, pregnancy, menopause);
the influence of ultraviolet rays (prolonged exposure to the sun or solarium);
taking contraceptives;
allergic or inflammatory skin diseases.

Types of blue nevus

Medical practice divides the blue nevus into three subspecies:

Simple - no more than 1 cm, with a smooth surface and dense in consistency. It can manifest itself on the body (more often the hands), face (including the décolleté area) and mucous membranes (uterus, vagina, oral cavity).
Cellular - can reach sizes up to 3 cm, has a dark blue color with irregularities. For this subspecies, the location is typical only on the body (lumbar region, buttocks, hands and feet).
Combined - in this case, the blue nevus is combined with other types of dangerous and non-dangerous moles.

What is the danger of a blue nevus?

A formation such as a blue nevus can be a harbinger of melanoma.

Although such cases are extremely rare in medical practice, you should not be frivolous about this mole.

One of the subspecies of blue nevus can reach up to 3 cm in size.

Signs of a malignant process

A malignant blue nevus will betray itself with the following changes:

the rapid growth of a blue mole;
the manifestation of pain when pressing on such an education;
burning, itching and peeling spots;
change in color shade;
uneven surface;
hair growth on a mole;
discharge of fluid (blood) from the nevus.

Moles of this type are most susceptible to the malignant process, which are located on the body in an area with a traumatic factor (lumbar region, hands in the area of cuffs, collar area on the neck, as well as on the face).

Uneven edges of the formation - a reason to see a doctor for research.

Treatment and removal of a blue nevus

In the case when the blue nevus does not have malignant signs, its treatment is not required.

Treatment by removing the formation is used in an uncomfortable position (which carries the risk of injury) or there is a threat of degeneration of a blue nevus into melanoma.

Such formation can be treated with various methods, depending on the place of its localization and size:

radio wave method;
cryodestruction;
laser removal;
electrocoagulation.

If it is not possible to diagnose a blue nevus (similarity to melanoma), then a mandatory excision of the formation by surgery is required.

In this case, part of the healthy cells under the skin is also subject to removal. After the operation, samples of education are sent for histological examination.

Blue skin nevus: what is it, photo, removal

(blue nevus of Jadasson-Tiche) is an acquired pigmented neoplasm of the skin of a small size, which has a characteristic dark blue or light blue color. As a rule, such formation is single, but in some cases there are multiple blue nevi. This nevus belongs to benign, but melanoma-prone formations. In rare cases, it can become malignant with the development of melanoma. In the treatment of a blue nevus, a wait-and-see approach is usually followed and the nevus is removed only when it is significantly enlarged or other changes that may be a sign of malignant degeneration.

General information

Blue nevus occurs in people of any age group, but most often appears during puberty. It is characterized by slow growth and does not cause any subjective sensations in the patient, so it can go unnoticed for a long time. Blue nevus is more common among women than among men.

Symptoms of a blue nevus

A blue nevus is a clearly demarcated oval, round or fusiform nodule located inside the skin. It usually has a size of up to 1 cm in diameter, in some cases nevi up to 3 cm in size were observed. The dark blue, blue or blue-black color of the nevus is uneven and is caused by the accumulation of large amounts of melanin in the deep layers of the skin. The nevus may rise slightly above the surface of the skin or not protrude above it at all. Looking at it, one gets the impression that there is some kind of foreign body under the skin. The surface of the blue nevus is smooth without hair growth, the texture is dense and elastic.

The nevus is located on the back of the feet and hands, on the legs and forearms, on the buttocks, less often on the face or in the mouth. It usually does not cause itching, soreness, or any other sensation. A blue nevus is the only cause of discomfort if it is located in a place where it is constantly injured. It is possible to suspect the transformation of a blue nevus into melanoma by the changes occurring in it: accelerated growth, color change, a decrease in the clarity of the contours, the appearance of unpleasant sensations in the area of the nevus.

Distinguish between simple and cellular forms of blue nevus, as well as combined nevi. A simple blue nevus is a single nodule up to 1 cm in diameter with a smooth surface and a densely elastic consistency. It can be of any color ranging from light gray to black-blue. The favorite location of such a nevus is the neck, face and hands, but it may appear on the trunk, oral mucosa, cervix and vagina.

Cellular blue nevus is large (1.5-3 cm) and dark blue in color, its surface may be uneven. Because of these features, it is often mistaken for a malignant neoplasm. In half of the cases, the cellular nevus is detected on the lower back or buttocks, less often it is located on the dorsum of the feet and hands. A combined nevus is a combination of a simple blue nevus with an intradermal, borderline, or pigmented nevus complex.

Diagnostics of the blue nevus

The small size, pronounced delimitation and characteristic color in many cases suggest the diagnosis of a blue nevus. For a more accurate diagnosis, dermatoscopy is performed - a visual study of the depth, boundaries and structure of the nevus with magnification. Siascopic examination allows you to determine the nature of the distribution of melanin and study the structure of the nevus. A blue nevus is differentiated from a borderline nevus, dermatofibroma, melanoma. In difficult cases, for differential diagnosis with melanoma, ultrasound of a skin neoplasm can be used, which determines the depth of germination and malignant infiltrative growth.

Histological examination, carried out after removal of the blue nevus, reveals accumulations of melanocytes in the middle and lower layers of the dermis. A simple blue nevus is characterized by an accumulation of melanin-filled cells. Cellular nevus is represented by large cells with a low pigment content. These cells are grouped into islets, separated by connective tissue bridges.

Blue nevus treatment

malignancy, surgical excision of the nevus is performed. Excision of the nevus is carried out together with the subcutaneous fatty tissue and an area of healthy skin 5-8 mm wide from the visible border of the nevus. When removing a nevus on the face, for a better cosmetic effect, the width of the captured area of healthy skin can be reduced to 3-5 mm. The removed nevus must undergo histological examination.

“Blue nevus” is a medical term used to denote a birthmark on the epidermis. It is initially non-malignant. It appears as a result of the movement of the melanoepithelioblast in the development of prenatal formation.

A birthmark consists of a large number of nevocytes, which are incorrectly altered melanocytes, which melanin normally secretes to stain the epidermis.

The blue birthmark Yadassono-tiche is a well-known formation of a small volume with an individual bright color or even more intense color. In most cases, the provided pigment spots are placed alone, but still there are times when there are many of them. Since there is a possibility of the transition of a nevus to melanoma, therapy is carried out only with an increase in volumes, the appearance of systematic friction and injuries in places, and even with other changes in its usual characteristics.

It is not typical for a blue nevus to plunge a predetermined age group of people, with all that the maximum number of initial manifestations is noticed during puberty. As it increases, it does not awaken uncomfortable feelings, thanks to this, for a long time, it remains undetected.

Taking into account the factors that the laying of moles is carried out again in utero. It should be emphasized those facts that contribute to the formation of nevi:

Phase changes in the concentration of hormones in the blood of a woman in a position.
Infectious disease of the genitourinary system of the expectant mother.
Genetic changes in the embryo.
In addition, it contributes to the impact of unpleasant circumstances, such as poisonous substances or radiation.

Due to the influence of these facts, disruptions in the formation and position of menoblasts are found in the body of the expectant mother, after which they in the future are collected in small groups and form a blue nevus.

There is a point of view, as if those birthmarks that formed on the epidermis at a fairly adult age are called "drowsy". They were laid in the womb, and under the influence of some factors, they became visible only after a certain time.

Throughout life, on the body of a human individual, to express the effects of different facts, as a result of which a blue nevus initiates a personal increase. The interval between such initial facts must be taken into account for:

Physical hormonal surges, for example, changes in the body during adolescence, pregnancy, breastfeeding, and menopause.
When using hormonal contraceptives.
The influence of ultraviolet rays when visiting a solarium. Being in the open sun for a long time without protective equipment, especially at the peak of solar activity from 11:00 to 15:00.
For skin allergic or inflammatory diseases.

Variety of birthmarks

All neoplasms differ in their individual structure, it is by this structure that they distinguish it, and decide how to further treat it. Their size ranges from 0.5 centimeters to a whole part of the body, or several parts of the body.

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Not every cellular collection of a birthmark is capable of generating the formation and growth of melanoma, as a result of which it is customary to divide all birthmarks into dangerous and non-dangerous. The first type of pigment spots is attributed to a blue nevus, borderline, huge, pigmented nevi, Dubreus's melanosis, in addition, Ott's nevus. All of the above birthmarks occupy about a fifth of all nevi.

As for the nevoid formations, a transition to a malignant melonoma is not inherent for them, it should be distinguished here: verrucous, fibroepital, Setton's nevus, verrucous and intradermal-pigmented.

Severe manifestations

The stained blue nevus is located in the thickness of the skin, its distinct outlines are observed, and visually resembles a small node, spindle-shaped or round configuration. Basically, its volume does not exceed one centimeter, but occasionally moles of about 3 cm are observed. The blue or dark blue tone inherent in a nevus covers the surface of the mole, unevenly. The characteristic shade is determined by the huge concentration of melanin in deeply located layers of the skin.

The provided neon-shaped formation can look above the level of the epidermis, or it can be at the same level. After a visual examination of the birthmark, it can be assumed that a foreign object of dense density is located under the skin. On the surface of the birthmark, no irregularities or hairline are examined.

The characteristic place of birthmark formation is the legs, buttocks, shoulders, the back surface of the foot, and the hands. Not so densely you can see the nevus on the face and head.

Basically, a blue nevus does not cause any unpleasant sensations or pain. Although, if a birthmark is in the place of constant friction or injury, it can make itself felt.

Varieties of blue nevus:

The primitive form of a mole resembles a nodule, the size of which is no more than 1 centimeter. The surface is smoothed, the feel is impenetrable density. The color spectrum of such a spot can vary from asphalt to dark blue. It often focuses on the upper limbs, head, and its formation on the skin of the body, oral mucosa is also not excluded.
Cellular type - characterized by rather large volumes, which reach up to three centimeters. The color of such birthmarks is dark blue, and there are some irregularities on the surface. Its main position is the waist area, the place below the back, the back of the fingers and feet. Due to external data, this birthmark is often mistaken for melanoma.
A mixed type of nevoid formation is shown by a set of indicators, a blue nevus with a different type of mole, for example, difficult melocytic, borderline or intradermal nevi.

Possible complications

Since the pigmented blue nevus is a melon-hazardous formation, so if such birthmarks are found on the body, you should systematically observe it and, with minimal doubt, you should immediately go to the doctor.

Typical symptoms of the formation of a malignant process:

rapid growth of a blue nevus;
the occurrence of pain, scabies, peeling, and so on;
color conversion of the birthmark;
the appearance of hillocks on the surface of the nevus, in addition, an increase in hair on the spot;
change of distinct lines of a mole to more indistinct ones;
the appearance of a drop of blood from a mole is systematically detected, as a result of which it is constantly wet.

Melanoma often forms at the site of a blue nevus. When it has the following meanings:

large volumes from the moment of birth;
education at an early age;
huge dimensions, damage to individual parts of the body is possible;
an innumerable number of nevoid formations on the torso;
the location of the blue nevus at points with a continuous presence of a traumatic fact (belt, collar, and so on).

Treatment plan

If there are suspicious dubious symptoms of melanoma growth, the birthmark must be removed. Surgical removal is used only if the birthmark is concentrated in those parts of the body where there is constant injury. Actually, these facts lead to the growth of melanoma.

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Removal of a birthmark occurs in several ways:

radio wave method;
cryodestruction;
laser method;
electrocoagulation.

If you doubt the presence of a malignant process, you need to use the prompt removal of this formation. The excision is done together with the subcutaneous tissue, and up to 15 cm of uninfected tissue should be taken on the surface of the epidermis. This is required for the absolute destruction of the nevus. A systematic professional examination lowers the chances of melanoma growth and prolongs life by decades.