Generic selectors
Exact matches only
Search in title
Search in content
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Net Quiz
2012:78:6;776-776
doi: 10.4103/0378-6323.102402
PMID: 23075667

Solitary tumor with a peripheral depigmented patch and poliosis

Chih-Tsung Hung, Chien-Ping Chiang
 Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Correspondence Address:
Chien-Ping Chiang
Department of Dermatology Tri-Service General Hospital No. 325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City 114
Taiwan
How to cite this article:
Hung CT, Chiang CP. Solitary tumor with a peripheral depigmented patch and poliosis. Indian J Dermatol Venereol Leprol 2012;78:776
Copyright: (C)2012 Indian Journal of Dermatology, Venereology, and Leprology

An 11-year-old Taiwanese girl presented with a 2-year history of a flesh-colored tumor over a patch of white hair on the vertex of the scalp. Initially, the tumor was hyperpigmented, without any surrounding depigmented areas or white hairs since preschool age. Her medical history was unremarkable, and mental and developmental milestones were normal.

Dermatological examination revealed a 0.8-cm diameter, flesh-colored tumor surrounded by a 2-cm diameter, well-circumscribed depigmented halo with poliosis [Figure - 1]. There were no other white patches visible under a Wood′s lamp examination.

Figure 1: A 0.8 cm diameter, flesh-colored tumor surrounded by a 2 cm diameter, circumscribed depigmented halo with poliosis

Histopathological examination of a skin biopsy taken from the scalp tumor showed several nests of pale-staining epithelioid cells with moderately dense infiltration by lymphocytes and multiple giant cells in the papillary dermis [Figure - 2] and [Figure - 3]. The epithelioid cells were positive for the S-100 protein and melan-A [inset in [Figure - 3]].

Figure 2: Histopathology showing a wedge-shaped infiltration with nests of pale-staining epithelioid cells surrounded by dense lymphocytes in the papillary dermis (H and E, ×40)
Figure 3: Histopathology showing multiple giant cells with wreath-like nuclei in the papillary dermis (H and E, ×400); inset showing positive melan-A staining in these cells (×400)

What′s Your Diagnosis?

Diagnosis

Halo nevus associated with poliosis circumscripta

Discussion

Halo nevus, also known as leukoderma acquisitum centrifugum, is a melanocytic nevus surrounded by a depigmented ring. It shows a predilection for the back and mostly affects children and young adults, with a mean age of 16 years. [1] Histopathologically, it is characterized by the presence of nevomelanocytic cells surrounded by mixed inflammatory cells, including lymphocytes, histiocytes, and occasional mast and plasma cells. Epithelioid granuloma may sometimes be present. There are several other cutaneous tumors that exhibit the clinical halo phenomenon, including neurofibroma, histiocytoma, basal cell carcinoma, sarcoidosis, and lichen planus. It is necessary to combine clinical and pathological findings for the correct diagnosis. Poliosis is defined as localized white hairs and is associated with several lesions, including congenital nevus, neurofibroma, intradermal nevus, and melanoma. This condition is a rare presentation of halo nevus.

There were several reports of halo nevus associated with the development of vitiligo. [2],[3] Gutte et al[3] reported a 22-year-old man who sustained a halo nevus with poliosis over his occipital scalp and developed extralesional vitiligo over his left knee. The authors suggested that halo nevus should be excised as early as possible to prevent progression to vitiligo. [3] We conducted a Wood′s lamp examination on our patient, but did not find any other whitish patches or halo nevi in her body.

The mechanism underlying the development of halo nevus is still uncertain. On the basis of the infiltration of mononuclear cells observed in most halo nevi, it is possible that an immunologic response plays a role in the pathogenesis of the condition. Zeff et al[4] proposed that cytotoxic CD8 + T cells are the effectors that destroy nevomelanocytes. Gutte et al[3] proposed that CD8 + T cells may also be related to the vitiligo lesions located distant to the nevi.

The differential diagnosis of the present case includes juvenile xanthogranuloma, which is a benign histiocytic disorder with a predilection for the head and neck that principally appears in the first 2 decades of life. Histopathological features include the presence of monomorphous histiocytes and Touton giant cells with a ring of nuclei surrounded by a foamy cytoplasm. [5] In our patient, we observed numerous giant cells with wreath-like nuclei, but no vacuolated cytoplasm. Immunohistochemistry was helpful for distinguishing nevomelanocytic cells from histiocytes. On the basis of the positive staining for S-100 protein and melan-A, we confirmed that the epithelioid cells were, in fact, nevomelanocytic cells.

When clinical dermatologists find patients with poliosis, the diagnosis of halo nevus should be considered. Due to the association between halo nevi and vitiligo, we suggest a thorough Wood′s lamp examination.

References
1.
Mooney MA, Barr RJ, Buxton MG. Halo nevus or halo phenomenon? A study of 142 cases. J Cutan Pathol 1995;22:342- 8.
[Google Scholar]
2.
Hofmann UB, Brocker EB, Hamm H. Simultaneous onset of segmental vitiligo and a halo surrounding a congenital melanocytic naevus. Acta Derm Venereol 2009;89:402-6.
[Google Scholar]
3.
Gutte R, Khopkar U. Extralesional vitiligo over knee following halo nevus with poliosis on the scalp. Indian J Dermatol Venereol Leprol 2011;77:522-5.
[Google Scholar]
4.
Zeff RA, Freitag A, Grin CM, Grant-Kels JM. The immune response in halo nevi. J Am Acad Dermatol 1997;37:620-4.
[Google Scholar]
5.
Dehner LP. Juvenile xanthogranulomas in the first two decades of life: A clinicopathologic study of 174 cases with cutaneous and extracutaneous manifestations. Am J Surg Pathol 2003;27:579-93.
[Google Scholar]

Fulltext Views
534

PDF downloads
213
Show Sections