Bluish Gray Pigmented Macule on Right Cheek

Abstract

Dermal melanocytosis is characterized by bluish gray color of lesion, location which develop due to entrapment of migratory dendritic melanocytes in dermis during fetal development. Four clinically distinct entities are nevus of Ota, nevus of Ito, Mongolian spots, and nevus of hori. We are describing a case of 22 year old male with single hyperpigmented macule on left cheek with scleral involvement. Histopathology showed presence of elongated dendritic melanocytes in dermis. Diagnosis of nevus of Ota was made. Nevus of Ota also known as oculodermal melanocytosis because it typically involves distribution areas of ophthalmic and maxillary division of trigeminal nerve. Clinically it is characterized by unilateral speckled bluish gray colored macule with or without ocular and oral mucosa involvement. The lesion tends to persist and increase in size locally, becoming increasingly prominent with age. Diagnosis is usually clinical but sometimes biopsy may be required to rule out close differentials including nevus spilus, melasma, blue nevus and cafe-au-lait macule. Important associated disorders include ipsilateral glaucoma; intracranial melanocytosis; and rarely cutaneous, ocular, or intracranial melanoma. Treatment with multiple sessions of pulsed Q-switch lasers (ruby, alexandrite, nd:yag) are first choice and have shown almost complete clearance.