Published in Dermatology

Journal Scan / Research · September 01, 2020

Association Between Halo Nevi and Melanoma in Adults

Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

• In this retrospective review, the charts of adult patients with a new diagnosis of halo nevi (HN) were reviewed to determine the rate of melanoma development within 1 year of when the HN diagnosis was made. In the 879 patient charts reviewed, 95 melanomas were found. Only 9 occurred within 1 year of HN development, which yielded a melanoma incidence rate in patients with HN diagnosis of 0.01 per person per year. The remaining 86 melanomas occurred either before the HN diagnosis or after a 1-year period. This study suggests that, in an adult who develops new-onset HN, the risk of developing a cutaneous melanoma is as low as 1% per person per year. This risk is similar to that incurred by having multiple atypical nevi or a personal or family history of melanoma.

• The authors conclude that an annual skin cancer screening examination is adequate for screening for melanoma in these patients with new-onset HN.

– Margaret Hammond, MD

Written by

 

 

Christine Jaworsky MD

This pivotal study is a significant multicenter, retrospective chart analysis of clinical and histologic records at eight university hospitals. The authors identified 879 adults over the age of 18 with a total of 888 halo nevi diagnoses. Patients who were treated for melanoma with immunotherapy were excluded. There were 95 occurrences of melanoma in the study population. In 78 patients, melanoma preceded a halo nevus. In 9 patients, halo nevi were diagnosed up to 1 year prior the diagnosis of melanoma. In 8 patients, a primary cutaneous melanoma occurred more than 1 year after a halo nevus was detected. All the melanomas diagnosed were primary cutaneous melanomas; none were primary extracutaneous melanoma, metastatic melanoma, or synchronous melanoma in a halo nevus. All the halo nevi were single, not multiple, in patients identified with melanoma.

The literature to date advocates for extensive melanoma screening for primary and visceral melanomas in adults with a halo nevus despite evidence supporting an association between halo nevi and melanoma. The authors' finding of a 1% risk of developing a primary cutaneous melanoma in the year following a halo nevus indicates that there is no need for an exhaustive cutaneous and systemic workup in adult patients with a new-onset halo nevus. The risk of developing a melanoma in adult patients with a halo nevus is similar to that of patients with atypical nevi or a personal/family history of melanoma. The authors state that a history of vitiligo and a halo nevus is not significantly associated with risk of melanoma. It would be interesting to see if the same holds true in the less common patients with multiple halo nevi.

Abstract

The halo nevus (HN) is thought to be of little concern in children. In adults, however, a new-onset HN has been suggested to be a harbinger of melanoma – either within the HN or at distant cutaneous or non-cutaneous sites – based on case reports and small case series.1,2 Multiple widely-used dermatologic reference texts3,4 and online references (such as UpToDate.com, DermNetNZ.org) advocate for extensive melanoma screening in adults with new-onset HN, including full cutaneous, oral, ophthalmic, and vaginal examinations, despite limited evidence supporting an association between HN and melanoma. We aimed to further investigate the association between new-onset HN and melanoma in adults by evaluating the incidence of melanoma in the year following a new HN diagnosis.

Journal of the American Academy of Dermatology

Association Between Halo Nevi and Melanoma in Adults: A Multi-Center Retrospective Case Series

J Am Acad Dermatol 2020 Aug 18;[EPub Ahead of Print], D Haynes, JL Strunck, J Said, I Tam, A Varedi, CA Topham, B Olamiju, BM Wei, MK Erickson, LL Wang, A Tan, R Stoner, RI Hartman, E Lilly, D Grossman, JA Curtis, JS Westerdahl, JS Leventhal, JN Choi, EY Chu, ME Ming, JA Stein, TN Liebman, E Berry, TM Greiling 

Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

Please excuse the shortness of this message, as it has been sent from
a mobile device.