Blue nevus-like and blue nevus-associated melanoma: a comprehensive review of the literature.
BACKGROUND
Malignant blue nevus, blue nevus-associated melanoma and blue nevus-like melanoma are all terms used to describe malignant melanomas arising from, in association with, or resembling blue nevi. This review is aimed at summarizing the available literature to reduce the confusion surrounding this rare malignancy, and aid the surgeon in choosing further diagnostic or therapeutic measures.


METHODS
We conducted a search of Medline, Embase, Science Direct, Scopus and the Cochrane Library for all full text articles published in English that reported on a malignant melanoma arising from, in association with, or resembling a blue nevus.


RESULTS
We identified 91 cases that fit the criteria above. The mean age at diagnosis was 45 years, with a slight male predominance (males: 48; females: 43). Metastatic cases were reported in 55% (n = 50), of which 16 were metastatic at the time of diagnosis, 16 developed metastases within the first year and 18 within 5 years of initial diagnosis. The mean Breslow thickness was 6.8 mm at the time of diagnosis (n = 39).


CONCLUSIONS
The histological criteria for diagnosing this malignancy are very poorly defined, and may contribute to the substantial confusion surrounding the terminology. There is no consensus on which prognostic indicators predictive of outcome in 'conventional' malignant melanoma are applicable to blue nevus-like melanoma/blue nevus-associated melanoma. However, two larger case series have demonstrated a significant association between Breslow thickness (or largest tumour dimension when non-epidermal) and recurrence-free survival, as well as rate of local recurrence, but larger studies are needed to confirm this.
Department of Surgery, Ostfold Hospital Trust, Kalnes, Norway.
Thore L
http://orcid.org/0000-0002-3607-2482
TL
Borgenvik
Department of Surgery, Ostfold Hospital Trust, Kalnes, Norway.
Tina M
TM
Karlsvik
Department of Plastic Surgery, St. Andrew's Centre for Burns and Plastic Surgery, Chelmsford, UK.
Saikat
S
Ray
Department of Plastic Surgery, Norfolk and Norwich University Hospitals, Norwich, UK.
Monica
M
Fawzy
Department of Plastic Surgery, East and North Hertfordshire NHS Trust, Stevenage, UK.
Nick
N
James
D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008544:Melanocytes / Q000378:metabolism / Q000473:pathology*; D008545:Melanoma / Q000235:genetics / Q000473:pathology / Q000556:secondary*; D008875:Middle Aged; D018329:Nevus, Blue / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D012878:Skin Neoplasms / Q000235:genetics / Q000473:pathology* / Q000556:secondary; D000096142:Cutaneous Malignant Melanoma
blue nevus; cellular blue nevus; malignant melanoma; melanocytes; skin neoplasms