Sequential Dermoscopy and Reflectance Confocal Microscopy Paired With Pigmented Lesion Assay Gene Expression Profiling for In Vivo Monitoring of Multiple Halo Nevi on an Adult Patient

Abstract

The halo nevus is characterized by a ring of depigmentation appearing around an acquired or congenital melanocytic nevus. When observed in children, halo nevi are generally not a cause of concern. However, adult-onset halo nevi have an associated risk of primary cutaneous melanoma that corresponds to the risk of melanoma in patients with atypical nevi or a personal/familial history of melanoma. Thus, new-onset halo nevi in adults requires close follow-up and monitoring for malignancy. Herein we present a case of an adult patient who received sequential digital dermoscopy, reflectance confocal microscopy, and pigmented lesion assay gene expression profiling to monitor two halo nevi over a three-month period.

Keywords: confocal; dermoscopy; gene expression profiling; halo nevi; halo nevus; in-vivo; pigmented lesion assay; reflectance confocal microscopy.

Figure 1. Halo nevus visualized on the left cheek at baseline visit.

Panel A indicates the location of a 5 mm pink-brown papule with a hypopigmented rim alongside a metric ruler. Panel B shows a dermoscopy of the lesion, with a globular-homogeneous pattern network and an absence of vessels. Panel C highlights reflectance confocal microscopy-enabled visualization of a clod pattern representing homogeneous dermal nests of melanocytes (yellow arrows) and a hair follicle (red star) without atypical cells.

Figure 2. Halo nevus visualized on the left lower abdomen at baseline visit.

Panel A indicates the location of the 7 mm pink-brown papule with a surrounding hypopigmented ring 1 cm in diameter. Panel B demonstrates an absence of vessels and a globular-homogeneous pattern network on dermoscopy. Panel C is a reflectance confocal microscopy-captured image of a honeycombed epidermis with milia-like cysts (yellow arrows) and areas of increased collagen (blue stars). There is an absence of pagetoid cells.

Figure 3. Follow-up imaging, three months from baseline, of the left lower abdomen halo nevus.

Panel A demonstrates unchanged dermoscopic features of a globular-homogeneous pigment network and panel B showcases a regular epidermis with reflectance confocal microscopy, composed of a honeycomb pattern, and an absence of pagetoid cells.

Figure 4. Follow-up imaging, three months from baseline, of the left cheek halo nevus.

Panel A indicates unchanged dermoscopic features of a globular homogeneous network and an absence of vessels. Reflectance confocal microscopy imaging of the lesion is shown in panel B, consistent with previous findings of dermal nests (yellow arrows), a hair follicle (red star), and an absence of atypical cells.