Dermatology: Practical and Conceptual


Letter  |  Dermatol Pract Concept 2020;10(3):e2020064 1

Dermatology Practical & Conceptual

Introduction

Meyerson phenomenon (MP) is an uncommon condition 

consisting of a symmetric area of eczema encircling a preex-

isting central cutaneous lesion such as a melanocytic nevus, a 

nonmelanocytic skin neoplasia, or a melanoma. MP has been 

reported to occur both in acquired melanocytic nevi in adults 

and congenital melanocytic nevi (CMNi) in the pediatric 

population [1].

Case Presentations

Case 1

A 2.5-year-old boy was referred to us for a small CMN of 

the back encircled by an eczematous patch (Figure 1A). The 

patient, who had been suffering from atopic dermatitis since 

birth, complained of itching. Dermoscopy revealed a multi-

component pattern, with atypical globules and blotches of 

pigment, a central blue veil, along with perilesional erythema 

(Figure 1B). Therapy with a topical mometasone furoate led 

only to transient improvement, with recurrence after discon-

tinuation and with persistence of the alarming dermoscopic 

features. Surgical excision of the lesion was performed and 

histology was suggestive of a CMN with MP. The excision of 

the lesion led to complete healing.

Case 2

A 6-year-old boy was referred to us for a medium-sized 

CMN of the right thigh that had progressively changed over 

the previous 12 months. On physical examination, a brown 

patch with ill-defined margins, 6 cm in maximum diameter, 

surmounted by yellow crusts and fissures, was observed 

(Figure 2A). The patient complained of itching and pain. He 

had suffered from atopic dermatitis during the first years of 

life, in remission at the time of consultation. Dermoscopic 

Congenital Melanocytic Nevi With Meyerson 
Phenomenon: Two Case Reports and 

Review of the Literature
Ambra Di Altobrando,1 Iria Neri,1 Annalisa Patrizi,1 Michela Tabanelli,2 Cosimo Misciali,1 

Carlotta Baraldi,1 Francesco Savoia1

1 Department of Experimental, Diagnostic and Specialty Medicine, Dermatology, University of Bologna, Italy

2 Dermatology Unit, AUSL della Romagna, Ravenna, Italy

Key words: congenital melanocytic nevus, Meyerson phenomenon, dermoscopy, dermatopathology, topical steroids

Citation: Di Altobrando A, Neri I, Patrizi A, Tabanelli M, Misciali C, Baraldi C, Savoia F. Congenital melanocytic nevi with Meyerson 
phenomenon: two case reports and review of the literature. Dermatol Pract Concept. 2020;10(3):e2020064. DOI: https://doi.org/10.5826/
dpc.1003a64

Accepted: March 31, 2020; Published: June 29, 2020

Copyright: ©2020 Di Altobrando et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are 
credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

Authorship: All authors have contributed significantly to this publication. Francesco Savoia and Ambra Di Altobrando equally contributed 
to the paper.

Corresponding author: Ambra Di Altobrando, MD, Via Massarenti 1, 40138 Bologna, Italy. Email: ambra.dialtobrando@studio.unibo.it

https://doi.org/10.5826/dpc.1003a64
https://doi.org/10.5826/dpc.1003a64
mailto:ambra.dialtobrando@studio.unibo.it


2 Letter  |  Dermatol Pract Concept 2020;10(3):e2020064

examination revealed areas charac-

terized by pigment network and areas 

with a homogeneous pigmentation, in 

association with scales and glomeru-

lar and dotted vessels (Figure 2, B and 

C). Moreover, short, linear black fibers 

of clothing entrapped in the irregular 

eczematous surface of the lesion were 

detected. The use of clobetasol propi-

onate 0.05% cream led to a reduction 

of the inflammation, without complete 

healing of the eczema, which recurred 

immediately after treatment discontin-

uation. A punch biopsy was performed 

and histopathology showed the features 

of a normal CMN associated with a 

chronic dermatitis, allowing the diagno-

sis of CMN with MP (Figure 2D).

Because of the severe pruritus and the 

chronic course despite therapy, seriate 

excisions were planned and performed, 

in order to achieve complete healing.

Discussion

MP involving CMNi in the pediatric 

population is rare (Table 1). The most 

important differential diagnosis is mel-

anoma, because the halo of eczema may 

cause clinical and worrisome dermo-

scopic features, including ‘‘blue-white 

structures’’ and ‘‘blue areas” [1].

Although MP can have a sponta-

neous complete resolution when asso-

ciated with CMN, some authors have 

reported a chronic course with complete 

healing achieved only after excision of 

the CMN [2]. The use of potent topical 

steroids is associated with faster healing, 

even though recurrence of MP can occur 

within the same nevus or in different 

lesions [2].

Figure 2. (A) A medium-sized congenital melanocytic nevus surmounted by yellow crusts and fissures. (B) Dermoscopy showed scales, glomer-

ular/dotted vessels, and short linear black fibers stuck to the eczematous surface. (C) Areas with a homogeneous pigmentation were observed 

on dermoscopy. (D) Histopathology showed the features of a normal congenital melanocytic nevus associated with a chronic dermatitis.

Figure 1. (A) A small congenital melanocytic 

nevus with Meyerson phenomenon. (B) Der-

moscopy revealed a multicomponent pattern, 

with atypical globules and blotches of pig-

ment, a central blue veil, along with perile-

sional erythema.



Letter  |  Dermatol Pract Concept 2020;10(3):e2020064 3

Conclusions

Our cases highlight the fact that in chil-

dren MP in CMNi can have a chronic 

course, with severe eczema, itch, and 

pain, and can be responsible for alarm-

ing dermoscopic features, simulating a 

melanoma.

References

1. Richey P, Radfar A, Kirkorian AY. Blue 

areas on dermoscopy of a congenital nevus 

with Meyerson phenomenon. J Am Acad 

Dermatol. 2015;73(5):e161-e163. https://

doi.dx.org/10.1016/j.jaad.2015.07.004.

2. Rolland S, Kokta V, Marcoux D. Meyer-

son phenomenon in children: observation 

in five cases of congenital melanocytic 

nevi. Pediatr Dermatol. 2009;26(3):292-

297. https://doi.dx.org/10.1111/j.1525-

1470.2009.00931.x.

3. Weijns ME, Houtappel M. An infant with 

a nevus on the upper leg [in Dutch]. Ned 

Tijdschr Geneeskd. 2017;161:D1532. 

PMID: 28880143.

4. Tauscher A, Burch JM. Picture of the 

month—quiz case. Diagnosis: Meyerson 

phenomenon within a congenital me-

lanocytic nevus. Arch Pediatr Adolesc 

Med. 2007;161(5):471‐472. https://doi.

dx.org/10.1001/archpedi.161.5.471

5. Pižem J, Stojanovič L, Luzar B. Melano-
cytic lesions with eczematous reaction 

(Meyerson’s phenomenon)—a histopatho-

logic analysis of 64 cases. J Cutan Pathol. 

2012;39(10):901‐910. https://doi.dx. 

org/10.1111/j.1600-0560.2012.01960.x.

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