Halo Nevi Research Articles

Digital quantification of PRAME for distinguishing melanoma from nevi compared to manual assessment

AimsIn this proof-of-concept study, we propose a new method for automated digital quantification of PRAME (PReferentially expressed Antigen of MElanoma) as a diagnostic aid to distinguish between benign and malignant melanocytic lesions. The proposed method utilizes immunohistochemical virtual double nuclear staining for PRAME and SOX10 to precisely identify the melanocytic cells of interest, which is combined with digital image analyse to quantify a PRAME-index. MethodsOur study included 10 compound nevi, 3 halo nevi, and 10 melanomas. Tissue slides were stained with PRAME, scanned, the cover glass removed, stained with SOX10, scanned again, and finally analysed digitally. The digitally quantified PRAME-index was compared with a manual qualitative assessment by a dermatopathologist using the standard PRAME-scoring system. ResultsThe digitally quantified PRAME-index showed a sensitivity of 70 % and a specificity of 100 % for separating melanomas from benign lesions. The manual qualitative PRAME-score showed a sensitivity of 60 % and a specificity of 100 %. Comparing the two methods using ROC-analyses, our digital quantitative method (AUC: 0.931, 95 % CI: 0.834;1.00, SD: 0.050) remains on par with the manual qualitative method (AUC: 0.877, 95 % CI: 0.725;1.00, SD: 0.078). ConclusionWe found our novel digital quantitative method was at least as precise at classifying lesions as benign or malignant as the current manual qualitative assessment. Our method has the advantages of being operator-independent, objective, and replicable. Furthermore, our method can easily be implemented in an already digitalized pathology department. Given the small cohort size, more studies are to be done to validate our findings.

Analysis of granulysin expression in vitiligo and halo-nevus

Vitiligo and halo nevus are immune-mediated skin diseases that have a similar pathogenesis and involve cellular cytotoxicity mechanisms that are not yet fully understood. In this study, we investigated the expression patterns of the cytolytic molecule granulysin (GNLY) in different cytotoxic cells in skin samples of vitiligo and halo nevus. Skin biopsies were taken from perilesional and lesional skin of ten vitiligo patients, eight patients with halo nevus and ten healthy controls. We analysed the expression of GNLY by immunohistochemistry in CD8+ and CD56+ NK cells. A significantly higher accumulation of GNLY+, CD8+ GNLY+ and fewer CD56+ GNLY+ cells was found in the lesional skin of vitiligo and halo nevus than in the healthy skin. These cells were localised in the basal epidermis and papillary dermis, suggesting that GNLY may be involved in the immune response against melanocytes. Similarly, but to a lesser extent, upregulation of GNLY+ and CD8+ GNLY+ cells was observed in the perilesional skin of vitiligo and halo nevus compared to healthy controls. In this study, we demonstrated for the first time an increased expression of CD8+ GNLY+ T lymphocytes and CD56+ GNLY+ NK cells in lesions of vitiligo and halo nevus, indicating the role of GNLY in the pathogenesis of both diseases.

Abnormal metabolism in melanocytes participates in the activation of dendritic cell in halo nevus

A comprehensive analysis of spatial transcriptomics was carried out to better understand the progress of halo nevus. We found that halo nevus was characterized by overactive immune responses, triggered by chemokines and dendritic cells (DCs), T cells, and macrophages. Consequently, we observed abnormal cell death, such as apoptosis and disulfidptosis in halo nevus, some were closely related to immunity. Interestingly, we identified aberrant metabolites such as uridine diphosphate glucose (UDP-G) within the halo nevus. UDP-G, accompanied by the infiltration of DCs and T cells, exhibited correlations with certain forms of cell death. Subsequent experiments confirmed that UDP-G was increased in vitiligo serum and could activate DCs. We also confirmed that oxidative response is an inducer of UDP-G. In summary, the immune response in halo nevus, including DC activation, was accompanied by abnormal cell death and metabolites. Especially, melanocyte-derived UDP-G may play a crucial role in DC activation.

Prognostic factors in childhood vitiligo.

Vitiligo is a multifactorial disease characterized by the progressive loss of melanocytes. The worldwide prevalence ranges from 0.5% to 2%, and in children from 0% to 2.16%. The objective of this study was to determine the variables associated with progression of vitiligo. A retrospective cohort was carried out where a random sample of records of pediatric patients with vitiligo from January 2016 to December 2020 was analyzed. The variables were studied: age at onset, sex, hereditary family history, personal history of thyroid diseases, time of evolution, classification, Köebner phenomena, mucosal vitiligo, halo nevus, premature graying and the presence of other dermatoses. The final state was classified as progression, stability, partial remission and complete remission. 574 children with vitiligo; 290 (50.5%) women, 284 (49.5%) men. Non-segmental vitiligo in 324 (56.4%), segmental vitiligo in 250 (43.6%). Mean age of onset 8.7 years (SD: 4.54). Median evolution time 6 months (25th percentile of 3 months and 75th percentile of 24 months). Family history 27 (4.70%). Thyroid disease 7 (1.21%). Evolution remained stable in 44 (7.7%), 68 (11.8%) had progression, 32 (5.6%) complete remission, 222 (38.7%) partial remission and 208 (36.2%) one consultation. Non-segmental vitiligo was obtained p < 0.028, younger age of onset p < 0.000, and none skin comorbidities p < 0.009. The variables that were associated with a more progression were non-segmental vitiligo, early ages at the onset of the disease, and not presenting with other skin diseases.

567 - Prognostic factors in pediatric patients with vitiligo

Abstract Introduction Vitiligo is a pigmentary disorder, and its prevalence reaches 2.16% in children.(1) Childhood vitiligo differs from adult vitiligo in clinical characteristics such as higher incidence in females, higher prevalence of segmental presentation and lower association with autoimmune disorders. (2) The course of vitiligo is unpredictable, the disease may regress, stabilize, progress and exacerbate. (3) Few studies of the course of vitiligo have been published. Objectives The aim of this study was to identify the clinical characteristics associated with the progression of vitiligo in children and adolescents and also to describe the epidemiological profile in our patients. Methods We analyzed the clinical records of a cohort of pediatric patients with vitiligo attended at Centro Dermatológico Dr. Ladislao de la Pascua in Mexico City. Vitiligo diagnosis was defined clinically and to classify patients with NSV we used the revised classification of the Vitiligo Global Issues Consensus Conference. The outcome was the progression of vitiligo, and it was defined as an increase in the extent of the disease at the last visit of follow-up of the patient. We extracted the following data: age at onset, presence of halo nevus, Koebner phenomenon, familial medical history of vitiligo, presence of autoimmune and thyroid disorders. The Koebner phenomenon was considered if lesions were present in areas of friction or if the parents reported their occurrence at sites of previous trauma. Statistical analysis was performed using software SPSS v.25. To calculate the follow-up time we calculate the number of days between the last visit to the first visit of the participant to the center. We define four states according to the clinical course of vitiligo: stable, partial remission, complete remission and progressión. Stable means that the affected body surface area (BSA) did not change over the time, partial remission that the BSA decreased, complete remission means a BSA equal to zero and progression an increase in the involved BSA. We made a survival analysis using Kaplan Meier curves. Results Of the 679 participants, 50.2% (341) were males and 49.8% (338) females, giving a male-to-female ratio of 1:1. The average age of onset was 8.6 years (SD 4.4 years). Non-segmental vitiligo (NSV) was more common (55.5%) than segmental vitiligo (44.5). Koebner’s phenomenon was observed in 22.5% of patients and halo nevus was diagnosed in 5% of them. Only 4.1% (28) of the patients had family history of vitiligo; 0.9% had thyroid disorders and 0.3% had been diagnosed with an autoimmune disorder. The mean time of follow up was 11 months. The clinical course of the patients was: stable 44.3%, partial remission 38.7%, complete remission 4.9% and progression in 12.1%. The median time to progression of vitiligo was 71 months equivalent to 5.9 years (95%CI 58.72-83.29 months). The mean time to progression for non-segmental vitiligo was 54.94 months vs. 61.94 patients with segmental vitiligo (p=0.087). Time to progression was different in patients with another skin disease 68.37 months vs. 54.53 months (p=0.015). There were no differences in time to progression for the following variables: treatment, age of onset, gender, family history, Koebner phenomenon, halo nevus and autoimmune disorders. Conclusions In our population childhood vitiligo has a slow progression rate and a low prevalence of family history and Koebner's phenomenon compared to other Latin American populations. (4) The ratio of non-segmental to segmental vitiligo and female to male were lower than other countries. (5) Studies with longer follow-up periods are needed to assess progression in vitiligo.

A gyermekkori nagyméretű és óriás festéksejtes anyajegyek eltávolításának szempontjai

The removal of common nevi is necessary only in case of irritation, changes causing complaints, or dermatological recommendations, in addition to regular inspections. In case of the need for surgical removal of special birthmarks (e.g. Spitz nevus, Halo nevus, etc.), a dermatological examination and recommendation are also essential. Congenital melanocytic nevus is a special entity. In 1-3% of newborn cases we encounter the small (&lt;1.5 cm) congenital melanocytic nevus, and less often a giant (≥40 cm) nevus. The number, localization and morphology of congenital melanocytic nevi are more important than size in terms of the probability of melanoma occurrence. The treatment of these nevi varies individually and requires teamwork (e.g. dermatologist, oncologist, surgeon, anesthesiologist, pediatrician). All skin incisions leave a scar, and the characteristics of lifelong scars are influenced by many factors. These include age and surgical technique. For plastic surgery performed in childhood, it is advisable to choose the simplest technique – but the one that leads to the most favorable later results – when possible, to avoid complicated flap plasties and skin replacement procedures. When developing the surgical strategy, it is essential to involve the parent and the child in addition to the allied professions, as well as keeping in mind the characteristics of childhood. In the optimal case, the completion of the reconstruction should carry out before get into community, but at the latest by the teenage years.

The role of reflectance confocal microscopy in the diagnosis and management of pigmentary disorders: A review.

Reflectance confocal microscopy (RCM) has quickly transitioned from a research tool to an adjunct diagnostic bedside tool, providing the opportunity for noninvasive evaluation of skin lesions with histologic resolution. RCM is an optical imaging technique that uses near-infrared excitation wavelengths and safe low-power lasers. En-face images of different skin layers (up to the superficial dermis) are acquired in grayscale based on the reflective indices of tissue components. Melanin has the highest reflective index (contrast) and appears bright on RCM. We present a review of the current literature on the use of RCM in the diagnosis and management of pigmentary disorders. We reviewed PubMed and Ovid Medline databases from January 2000 to June 2021, using MeSH key terms: "reflectance confocal microscopy, confocal laser scanning microscopy, pigmentary disorders, treatment, melasma, vitiligo, freckles, solar lentigo, lentigo, tattoo, complications, melanoma, skin cancers, pigmented lesions, post inflammatory, melanin, photoaging" to identify studies and review articles discussing the use of RCM in the diagnosis and management of pigmentary disorders. RCM findings of pigmentary disorders were divided into the following categories: (1) disorders of increased pigmentation (post-inflammatory hyperpigmentation, melasma, Riehl's melanosis, solar lentigines, ephelides, hori nevus, naevus of Ota, café-au-lait macules, melanocytic nevus, melanoma, nevus spilus, labial mucosal melanosis, and mucosal melanoma), (2) disorders of decreased pigmentation or depigmentation (post-inflammatory hypopigmentation, vitiligo, nevus depigmentosus, halo nevus), and (3) exogenous pigmentation (tattoo, ochronosis). RCM has been explored and proven valuable for the evaluation and management of pigmentary disorders including melasma, vitiligo, solar lentigines, tattoo, and tattoo-related complications.

Dermatologic care of patients with differences of sex development.

Differences of sex development (DSD or disorders of sex development) are uncommon congenital conditions, characterized by atypical development of chromosomal, gonadal, or anatomic sex. Dermatologic care is an important component of the multidisciplinary care needed for individuals with DSD. This article discusses the most common primary dermatologic manifestations of DSD in addition to the cutaneous manifestations of hormonal and surgical therapies in individuals with DSD. Published articles including case series and case reports on PubMed. Selection was conducted by examining existing literature with a team of multidisciplinary specialists. Narrative review. This article was not conducted as a systematic review. In Klinefelter syndrome, refractory leg ulcers and incontinentia pigmenti have been described. Turner syndrome is associated with lymphatic malformations, halo nevi, dermatitis, and psoriasis. Virilization can be seen in some forms of congenital adrenal hyperplasia, where acne and hirsutism are common. Dermatologists should consider teratogenic risk for treatments of skin conditions in DSD depending on pregnancy potential. Testosterone replacement, commonly used for Klinefelter syndrome, androgen insensitivity syndrome, 5-alpha reductase deficiency, gonadal dysgenesis, or ovotesticular DSD, may cause acne.

132 Differences in the immune microenvironment between improved and non-improved cases of vitiligo after halo nevus excision

132 Differences in the immune microenvironment between improved and non-improved cases of vitiligo after halo nevus excision

Differences in the immune microenvironment between improved and non-improved cases of vitiligo after halo nevus excision

BackgroundHalo nevus, also called Sutton’s nevus, is a nevus cell nevus surrounded by vitiligo thought to be caused by a T-cell mediated immune response to the nevus antigen. The immune microenvironment is mysterious, however, as vitiligo often does not improve even when the nevus cells are removed. ObjectivesTo analyze the clinical course and immune microenvironment of patients with halo nevus who had undergone nevus excision. MethodsWe collected 54 halo nevus patients and performed multivariate analysis and immunohistochemical analysis, including multiplexed immune cell phenotyping and spatial single-cell analyses using the PhenoCycler® assay. ResultsMultivariate analysis revealed that only the presence or absence of vitiligo vulgaris at the time of consultation was associated with improvement in the surrounding vitiligo following excision. Expression of programmed death-ligand 1 in nevus cells was significantly higher in non-improved cases compared with improved cases. The PhenoCycler® assay revealed that CD107a-positive and CD21-positive cells were more prevalent in improved cases than in non-improved cases. In the improved cases, active cell-cell interactions, centered on CD21-positive cells, were observed, whereas in the non-improved cases, cell-cell interactions were sparse. Instead, a dense infiltration of CD8-positive cells and CD3 and CD4-positive cells was observed in non-improved cases. ConclusionElucidation of the immune microenvironment of halo nevus is also relevant to melanoma-associated vitiligo and will contribute to our understanding of tumor immunity.

Dermoscopic features of an unusual case of targetoid hemosiderotic nevus

Targetoid hemosiderotic nevus (THN) is a rare variant of melanocytic nevus, characterized by a sudden development of a targetoid ecchymotic halo around a pre-existing nevus. THN clinically raises concern for malignant transformation due to its abrupt change in color and size. THN should be distinguished from other diseases showing a peripheral halo, including targetoid hemosiderotic hemangioma, halo nevus, and Meyerson nevus. Dermoscopy can help clinicians to differentiate THN from these diseases. The typical dermoscopic features of THN are known to be divided into two distinctive areas: the central melanocytic area and the peripheral ecchymotic area. In our case, dermoscopy revealed a novel bull’s eye pattern composed of a central area with characteristic features of benign melanocytic nevus, an intermediated white circular ring, and a peripheral milky red area. When a sudden change occurs in a pre-existing nodule showing targetoid features, dermoscopy should be considered before conducting a biopsy or surgical intervention.

A Case of Metastatic Melanoma in a Female Patient with Vitiligo

Patients with metastatic melanoma occasionally develop de novo hypopigmentation, pathologically indistinguishable from Sutton's nevus and common vitiligo, respectively. The case of a 68-year-old female with vitiligo of 2 years of evolution is documented, presenting a left inguinal mass and a para-aortic lymph node conglomerate. In the left inguinal region, a ganglion with thickened cortex and liquid content was identified. The laboratory results report hemoglobin of 8.30 g/dL, leukocytes 19.12 u/L, albumin 2.2 mg/dl, DHL 1222 Ul/L, alpha-fetoprotein 2 ng/ml, Ca-125 14.30 U/ml, Ca-19.9 8.60 U/ml and carcinoembryonic antigen of 2.14 ng/ml. Upon inspection, hypochromic, bilateral, and symmetrical lesions can be seen on the back of the hands, wrists, scalp, facial region, and neck. Biopsy showing malignant metastatic melanoma is performed. Starting management with Pembrolizumab 1 mg/kg every 21 days. Currently in follow-up and adjuvant treatment. Melanoma is the most aggressive form of skin cancer. The association of malignant melanoma with de novo hypopigmentation has been found, synchronously or following the diagnosis of the tumor. In recent years, it has led to the development of monoclonal antibodies. However, its diagnosis has implications for life prognosis due to high mortality.

Accelerated Repigmentation of Halo Nevus Following Excision: A Case Report

BACKGROUND: Halo nevus is a benign condition characterized by symmetrical oval-shaped and well-defined hypopigmented patch surrounding melanocytic lesions. Their sizes varies from a few millimeters to centimeters. A “wait and see” approach is usually preferred in most cases of halo nevus. However, the condition can cause severe psychological impact and impair patient’s quality of life, especially when it emerges on prominent areas such as the face. Surgical option can be utilized for removal of melanocytic lesions and accelerate regression of the halo. CASE PRESENTATION: We report a case of a 25-year-old woman with white patches around two moles on her face who was diagnosed as halo nevus. Surgical excision was performed and a 12-week follow-up showed reduction in diameter of the halo nevus. CONCLUSION: Large halo nevus can cause significant esthetic burden that may affect patient’s quality of life. A more invasive approach such as excision of underlying nevus may be used to achieve more rapid results.

Halo Nevi in the Pediatric Population

Halo Nevi in the Pediatric Population

Halo Nevi in the Pediatric Population

ABSTRACT Halo nevi are commonly observed in children and adolescents and may coexist with other disorders including vitiligo and Turner syndrome. This review discusses the epidemiology, pathophysiology, diagnosis, and management of halo nevi, with a particular emphasis on pediatric patients.

P-019 Semen analysis results are negatively affected in patients with vitiligo:a cross-sectional study

Abstract Study question Does vitiligo affect the results of semen analysis? Summary answer Semen analysis results are negatively affected in patients with vitiligo. What is known already Vitiligo is a multifactorial disorder characterized by the loss of functional melanocytes, and both genetic and non-genetic factors play a pathogenic role.Male infertility is also a common problem, contributing to almost 50% of all infertility problems.It was reported that skin-derived cytokines triggered in diseases with inflammation in the skin negatively affect spermatogenesis and sperm viability.Although vitiligo is a common skin disorder, the pathogenesis remains unknown. It was shown that inflammation and oxidative stress was accepted as a trigger factor in melanocyte degeneration.It was emphasized that the increase in inflammation in the body might be indirectly related to male infertility. Study design, size, duration This cross-sectional study was conducted between January 2015 and January 2021 by retrospectively evaluating patients who underwent sperm analysis at an university hospital. All patients aged between 25-45 years who underwent semen analysis at the relevant dates were evaluated in terms of the study (N = 5167).76 patients with vitiligo and 71 healthy controls were included in our study. The diagnosis of vitiligo was made clinically and using Wood's lamp. Participants/materials, setting, methods The control group was selected from among age and BMI-matched patients who underwent semen analysis (n = 71).The parameters examined in the study were as follows: Characteristics of cases (age, BMI, family history), Disease features (duration of disease, clinical type, Koebner phenomenon, halo naevi)The level of hormones [follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroxine (FT4), thyroid-stimulating hormone (TSH), testosterone, prolactin], and blood glucose, Semen analysis (volume, sperm concentration, total motility, A + B motility, morphology). Main results and the role of chance Seventy-six patients with vitiligo and 71 healthy controls were included in our study. The mean age was 30.29 ± 4.18 (range, 25-45) years. The mean age at onset was 23.66 ± 3.96 (range, 15-35) years, and the mean duration of disease was 6.36 ± 2.80 (range, 2-20) years in the vitiligo group. Sixty-seven (88.16%) patients had non-segmental vitiligo and nine (11.84%) had segmental vitiligo. Seven (9.21%) patients had a family history, three (3.95%) had Koebner phenomenon, and one (1.32%) patient had halo naevi.Free T4 levels were significantly lower in the vitiligo group than in the control group (P &amp;lt; 0.001) There were no significant differences between the groups regarding age, BMI, FSH, LH, TSH, testosterone, prolactin, and blood glucose levels. When we evaluated the semen analysis results, we found that sperm concentrations A+B motility and morphology were significantly higher in the controls than in the patients with vitiligo (P &amp;lt; 0.001,p&amp;lt;0.01,and P &amp;lt; 0.001) )There were no significant differences between the groups concerning volume and total motility. We divided patients with vitiligo into three groups according to their sperm concentrations.There were no significant differences between groups regarding age and BMI Free T4 levels were significantly higher in the control group than in the other groups. (p &amp;lt; 0.001). Limitations, reasons for caution The retrospective design of the study is an important limitation. Although the relationship between vitiligo and sperm parameters has been examined, the direction and cause of this relationship could not be determined due to the study design. Wider implications of the findings Inflammation and oxidative stress may affect sperm quality.One of the reasons for the more negative results in sperm analysis parameters in patients with vitiligo in our study might be due to increased inflammation level.Oxidative stress may be the trigger factor in the destruction of melanocytes as well as semen parameters. Trial registration number not applicable

Tofacitinib in paediatric dermatoses: a narrative review.

Tofacitinib has revolutionized the treatment of numerous dermatological conditions in different age groups. However, evidence for its effectiveness, safety and tolerability in the paediatric population is limited. We performed a literature search, which showed that oral tofacitinib is a reliable option in refractory juvenile dermatomyositis, severe alopecia areata, atopic dermatitis and psoriasis. Topical tofacitinib is an effective option in vitiligo and halo naevus. The risk-benefit ratio should be assessed prior to consideration of this molecule. In this narrative review, we have attempted to present a summary of the evidence of using tofacitinib (oral and topical) in paediatric dermatoses.

The delicate relation between melanocytes and skin immunity: A game of hide and seek

Melanocytes exhibit a complex and intriguing relationship with the skin immune response, leading to several clinical conditions. In some disorders, inappropriate melanocyte destruction (e.g., vitiligo, halo naevi) is problematic, while in others, immune tolerance should be broken (melanoma). Important parts of the dysregulated pathways have been unraveled in pigment disorders, ranging from upregulated interferon (IFN)-γ signaling to memory T cells, regulatory T cells, and immune checkpoints. Although a network of many factors is involved, targeting key players such as IFN-γ or checkpoint inhibitors (e.g., programmed death-ligand 1 (PD-L1)] can shift the balance and lead to impressive outcomes. In this review, we focus on the immunological mechanisms of the most common inflammatory disorders where the interaction of the immune system with melanocytes plays a crucial role. This can provide new insights into the current state of melanocyte research.

Spitz Nevus (case study)

Annotation. Spitz nevus is a difficult issue in the diagnosis of skin tumors and in the clinical tactics of management of patients with this disorder. The case of diagnosis of Spitz's nevus in patient R., born in 1978 is given. in which a dermatologist's examination revealed skin tumors on the torso and extremities. Spitz's nevus was suspected. Dermatological status: on the skin of the face, neck, torso and extremities there are spots and papules, up to 6 mm (number 62) maximum, light and dark brown, without signs of inflammation, irritation and trauma. Dermatoscopic picture of pigment formations is represented by melanocyte, non-melanocyte and halo nevi. On the skin of the left breast there is a melanocyte formation asymmetric in shape in the horizontal axis, dermatoscopically corresponding to the Spitz nevus (dark brown unstructured area in the center, illuminated to the periphery with large brown granules and dots located on the periphery of the focus in the form of rays 3.8. A biopsy was performed. Histologically, there is skin with acanthosis and minor hyperortokeratosis, located in the basal layer of symmetrical, well-defined formation with refractive artifacts. The tumor is formed by vertically placed junctional nests of mainly spindle-shaped, as well as epithelioid multinucleated melanocytes with eosinophilic cytoplasm, moderate polymorphism of vesicular nuclei. The latter have numerous prominent small basophilic nucleoli. Mitotic figures and pegetoid growth are absent. Perivascular lymphocytic infiltrates are present in the papillary layer of the dermis. The patient was diagnosed with Nevis Spitz. It is recommended to monitor dynamically with dermatoscopy once a year, to avoid hyperinsolation, the use of sunscreen with SPF factor. The problem of diagnostic and treatment tactics of a patient with Spitz's nevus remains a difficult problem today. Further study of the peculiarities of Spitz's nevus in adulthood seems promising.

White halo around a congenital melanocytic naevus

&lt;p class="abstract"&gt;This is a case report of Sutton nevus/ Halo naevus/ leukoderma acquisitum centrifugum in a young boy around congenital melanocytic naevus without any associated vitiligo. Halo naevi occur in 1% of the white population. The prevalence is higher in patients with Turner syndrome. It can occur at any age but frequently occurs in a young person. It can be associated with vitiligo and turner syndrome. Postulated pathogenesis is destruction of the melanocytes by cytotoxic T cells. There is frequently lymphocytic infiltration around the naevus in the histopathological examination, and ultrastructurally we can see cytotoxic changes in the naevus cells. It is mainly seen around the acquired congenital naevus but can also occur around spitz naevi, neurofibroma, primary or secondary malignant melanoma. 50% Sutton naevus regress in months to years. Usually, no treatment is required unless, when in doubt, you can do an excision biopsy. Our patient was managed conservatively and followed every six months. This case is being reported because of the condition's rarity and for learning purposes. &lt;/p&gt;