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.)
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