case18

Sunburn and Halo Naevus- a case report and Photo quiz

Alin Laurentiu Tatu1, Lawrence Chukwudi Nwabudike2

1Faculty of Medicine and Pharmacy, University ,,Dunarea de Jos “, Galati, Romania

2N. Paulescu Institute of Diabetes, Str. I.L. Caragiale, Nr. 12, Sector 2, Bucharest, Romania

 
Corresponding author: Alin Laurentiu Tatu, MD PhD, E-mail: dralin_tatu@yahoo.com

 

Submission: 03.03.2017; Acceptance: 10.03.2017

DOI: 10.7241/ourd.2017e.7

How to cite this article: Tatu AL. Sunburn and Halo Naevus- a case report and Photo quiz. Our Dermatol Online. 2017;8(1e):e8.

 


 

Introduction
This 31-year old female patient presented with a red, burning band of skin, following sun exposure, with an area that appeared unaffected by sunlight (Fig. 1). The patient occasionally covered the apparently unaffected area (though not this time) for protection.
Figure 1: Sunburn and nevi with a white halo
 
Question
Based on the clinical scenario and photograph presented, which would be the best option?
 
Answers
A. Reassure, patient and advice on sun protection as well as to return immediately if there are new changes to the lesion as it is a halo nevus and therefore benign
B. Excise lesion immediately as it is a melanoma, aggravated by sunburn
C. Refer for psychiatric consult as this is clearly a factitious dermatosis
D. Electrocautery would be recommended for this obvious verruca vulgaris.
 
Discussions
A. This is a halo nevus, by virtue of the presence of a nevus, surrounded by an area of vitiligo-like depigmentation. Halo nevi are benign lesions often seen on the trunk. Peak age of onset is about 15 years. There does not appear to be any racial or sexual predilection. Histologically, a dense, bandlike infiltrate of lymphocytes is present in the papillary and, sometimes, reticular dermis. The halo area is completely bereft of melanocytes, similar to vitiligo lesions. This infiltrate is comprised chiefly of T lymphocytes, especially of the CD8+ variety, which role is not fully elucidated.
Patients should be informed of the benign nature of the lesion, but also instructed to return immediately a change, such as pain, itch, or change in appearance is detected, in order to assess for a potential melanoma.
 
B. This is not a melanoma. Most melanomas appear de novo. However, it is an important differential in this case, with sunburn as a risk factor. The halo surrounding the benign-looking lesion is a giveaway. Thus surgery is unnecessary.
 
C. It is of course possible for the patient to have covered their nevus, thus provoking such an appearance. This patient occasionally actually did, a fact which does not necessarily imply a psychological disorder. However, psychodermatoses are to be considered after organic causes have been eliminated, such as the classic appearance of a halo nevus.
 
D. This is another possible differential, but verruca are usually brown or dark in colour, not pink, as is this lesion.
 
Differential diagnoses:
1. Halo nevus
2. Nodular malignant melanoma with regression
3. Verucca vulgaris
4. Vitiligo
 
Conclusions 
The patient was treated for the sunburn with ibuprofen and topicaly with wet alcoholic compresses and methylprednisolone aceponat milk.She was told to protect all the skin with a sunscreen because many melanoma arise de novo and the change to malignancy from one nevi is low.
 
References:

1. Halo nevus emedicine http://emedicine.medscape.com/article/1057446-overview#a3
2. Aouthmany M, Weinstein M, Zirwas MJ, Brodell RT. The natural history of halo nevi: a retrospective case series. J Am Acad Dermatol. 2012;67:582–6. 
3. Rongioletti F, Cecchi F, Rebora A. Halo phenomenon in melanocytic nevi (Sutton’s nevi). Does the diameter matter? J Eur Acad Dermatol Venereol. 2011;25:1231–2.
 
Notes

Source of Support: Nil,

Conflict of Interest: None declared.


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