Are You Confident of the Diagnosis?
What you should be alert for in the history
Eruptive nevus describes a clinicopathologic entity in which nevi “erupt” in a variety of different clinical settings, typically in relationship to derangements in immunity. Rather than nevi developing slowly over long periods of time, patients with eruptive nevi have a number of nevi manifest themselves a relatively short period of time.
Patients undergoing immunosuppressive therapy following transplantation or for the treatment of systemic disease, patients receiving chemotherapy, patients infected with Human Immunodeficiency Virus (HIV) with Acquired Immuno-Deficiency Syndrome (AIDS), patients with internal malignancy, patients following erythema multiforme or Stephens-Johnson syndrome, patients with severe bullous disease, and pregnant patients have all been described to produce nevi in an eruptive fashion. Of note, there is no consistent correlation with the clinical setting of the eruptive nevi and either their anatomic distribution or their histopathologic appearance, although the palms and soles appear to be preferred sites in eruptive nevi related to exogenous medications.
Expected results of diagnostic studies
A variety of microscopic forms have been described in eruptive nevi. Ordinary nevi without cytologic or architectural atypia are the most commonly encountered lesions and can be junctional, compound or intradermal. However, eruptive nevi exhibiting dysplastic architecture and cytology has been described. In addition, eruptive blue nevi and eruptive Spitz nevi have been described.
Finally, the eruption of severely atypical intraepidermal melanocytic proliferations with histomorphologic features of melanoma in situ (lentigo maligna) have been described. Clinicopathologic correlation is particularly critical in the latter setting since the residual (not biopsied) pigmented lesions in these patients appear to regress following the discontinuation of the inciting chemotherapeutic agent.
Who is at Risk for Developing this Disease?
Eruptive nevi are classically associated with immunosuppressive agents and chemotherapy but can be found in the other clinical scenarios described above.
What is the Cause of the Disease?
The underlying pathophysiology is not clear, but may be related to either iatrogenic or disease-induced immunodysregulation in some but not all cases.
Systemic Implications and Complications
Eruptive nevi are benign lesions and do not have any systemic implications in themselves, although they are commonly associated with one of the systemic scenarios described above.
Eruptive nevi are benign lesions and do not need to be treated. If there is question as to the diagnosis, a biopsy would be appropriate.
Optimal Therapeutic Approach for this Disease
No treatment is necessary for eruptive nevi. If a lesion is clinically concerning for being a melanoma, a biopsy should be considered.
No follow-up is needed.
Unusual Clinical Scenarios to Consider in Patient Management
In the absence of any obvious precipitant, such as a bullous disorder, pregnancy, chemotherapy, etc, consideration could be given to assessment for an underlying disorder with potential immunodysregulation, such as HIV.
What is the Evidence?
Bogenrieder, T, Weitzel, C, Scholmerich, J, Landthaler, M, Stolz, W. "Eruptive multiple lentigo-maligna-like lesions in a patient undergoing chemotherapy with an oral 5-fluorouracil prodrug for metastasizing colorectal carcinoma: a lesson for the pathogenesis of malignant melanoma?". Dermatology. vol. 205. 2002. pp. 174-5.(A case report of an eruptive melanocytic process with marked cytologic atypia of the melanocytes.)
Bovenschen, HJ, Tjioe, M, Vermaat, H, de Hoop, D, Witteman, BM, Janssens, RW. "Induction of eruptive benign melanocytic naevi by immune suppressive agents, including biologicals". Br J Dermatol. vol. 154. 2006. pp. 880-4.(An overview of the topic.)
Copyright © 2017, 2012 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
Sign Up for Free e-newsletters
- Hodgkin Lymphoma Survivorship Marked by Periods of Actionable Distress
- Dose-Escalation Mitigates Risk of Grade 3/4 Adverse Events With Ruxolitinib for Myelofibrosis
- Stem Cell Transplantation Superior to Chemotherapy for Relapsed/Refractory DLBCL, Follicular Lymphoma
- Integrative Medicine in Childhood Cancer: Practices That Can Help Pediatric Patients
- Patients and Caregivers Worry About Cost of Cancer Care
- Navigating Prostate Cancer: A Patient's Experience From Diagnosis to Survivor
- Cell Phones and Cancer Risk (Fact Sheet)
- How Likely Are Oncologists to Refer for Palliative Care? Depends on Their Age
- Chemoimmunotherapy Increases Survival in Triple-Negative Breast Cancer
- Seeking an Explanation for the Lack of Research Focused in Pediatric Oncology Therapeutics
- How to Help Patients at the End of Life and Their Loved Ones During the Holidays
- Real-World Prevalence of AEs With Immune Checkpoint Inhibitors for NSCLC Higher Than Reported in Trials
- Disparities Seen in Goals-of-Care Discussions With Minority vs Nonminority Patients
- Acupuncture Eases Some Self-Reported Symptoms of Cancer, Cancer Treatments
- Risk for Colon Cancer, Osteogenic Sarcoma Higher With Presence of Diamond-Blackfan Anemia
Regimen and Drug Listings
GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION
|Head and Neck Cancer||Regimens||Drugs|