The Long, Happy Life of the Halo Nevus

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The Long, Happy Life of the Halo Nevus

Understanding the prolonged natural history of these nevi may help patients avoid worry and unnecessary excision.

The halo nevus (HN) — a nevomelanocytic nevus surrounded by a rim of depigmentation (see figure) — occurs infrequently, usually in young patients. Appearance of the halo coincides with the regression of the nevus, and depigmentation is usually followed by complete repigmentation.

To characterize the natural history of these nevi, the authors of this retrospective chart review identified patients in a private dermatology practice who received a clinical diagnosis of HN in the years 1994 through 2010 and had a stored digital image of their original nevi; 36 patients with 56 HNs (mean age, 15.3 years; anatomic distribution, widely scattered) made a follow-up visit. One of the authors staged the nevi at follow-up and compared their appearance with the digital photographs. Seven nevi had been excised (6 for cosmetic reasons, and 1 melanoma). In the 49 remaining nevi, 25 demonstrated no change in the halo (stage 1), 7 nevi had regressed with halo, 2 had no residual nevus and persisting depigmentation, 4 were partially repigmented, and 11 had completely resolved, with normal pigmentation. In all, 78% of HNs failed to resolve during an average follow-up period of 5.6 years. The unchanged nevi remained as they were for a range of 0.8 to 14.5 years; those with complete resolution resolved after a range of 2.9 to 14.5 years.

Comment: The take-away lesson from this study is that halo nevi may persist, often for long periods. The authors note that reliance on patient recall at the initial evaluation for determining how long HNs had been present is a limitation; some nevi may have endured even longer than reported. It is satisfying to be able to tell patients that their HNs may persist stably for years without concern.

— Hensin Tsao, MD, PhD

Published in Journal Watch Dermatology September 28, 2012

Citation(s):

Aouthmany M et al. The natural history of halo nevi: A retrospective case series. J Am Acad Dermatol 2012 Oct; 67:582.

Medline abstract (Free)

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Halo nevi
Don W, 3 Jan 2013 12:08 PM EST
Specialty: Family Medicine
The synopsis comments that 1/56 turned out to be melanoma. The take home message doesn't address this concern

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