Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2024;14(2):e2024116 1

A Nodular Melanoma Mimicking  
a Blue Nevus: A Case Report

Giovanni Marco D’Agostino1, Tommaso Bianchelli1, Giulia Veronesi1,  
Valentina Di Gregorio1, Donatella Brancorsini2

1 Dermatology Unit, Istituto Nazionale di Riposo e Cura per Anziani, INRCA-IRCCS Hospital, Ancona, Italy

2 Institute of Pathological Anatomy and Histopathology, Polytechnic University of the Marche Region, Ancona, Italy

Citation: D’Agostino GM, Bianchelli T, Veronesi G, Di Gregorio V, Brancorsini D. A Nodular Melanoma Mimicking a Blue Nevus a Case 
Report. Dermatol Pract Concept. 2024;14(2):e2024116. DOI: https://doi.org/10.5826/dpc.1402a116

Accepted: December 10, 2023; Published: April 2024

Copyright: ©2024 D’Agostino et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication. G.M. D’Agostino and T. Bianchelli equally contributed to the 
manuscript.

Corresponding Author: D’Agostino Giovanni Marco, MD, Dermatological Unit, INRCA Ancona, Via della Montagnola 81, 60127, 
Ancona, Italy. Email: giovannimarcodagostino@gmail.com

Case Presentation

A 77-year-old female presented to our clinic for a routine 

consultation.

The examination showed at the right temporal region 

of the scalp a nodular lesion reported as having been pres-

ent for many years and clinically described as a blue nevus 

but recently enlarged in volume. The lesion was excised, 

dermoscopy showed aspects compatible with a blue nevus 

(Figure 1).

The diagnosis was nodular melanoma with Breslow of 

4 mm. Both sentinel lymph node and total body computed 

tomography (TBCT) were negative, and the patient is in 

 six-month clinical and instrumental follow-up.

Teaching Point

Blue nevus is a benign melanocytic lesion that rarely under-

goes malignant changes.

Melanoma rarely originates on blue nevi, and many of 

the reported cases are cellular blue nevi with lymph nodes 

containing nevi cells. 

There is no consensus about which prognostic indicators 

predictive of outcome in conventional malignant melanoma 

are applicable to blue nevus-like melanoma/blue nevus- 

associated melanoma, and the biological behavior of these 

lesions is not always predictable.

It is critical to focus on the story of rapid size increase even 

of lesions with reassuring clinical and dermoscopic aspects.



2 Image Letter | Dermatol Pract Concept. 2024;14(2):e2024116

References 

1. Longo C, Scope A, Lallas A, Zalaudek I, Moscarella E, Gardini S,  

Argenziano G, Pellacani G. Blue lesions. Dermatol Clin. 2013 

Oct;31(4):637-47, ix. doi: 10.1016/j.det.2013.07.001. Epub 2013  

Aug 23. PMID: 24075551.

Figure 1. A) Clinical and B) dermoscopic image of the lesion.

2.  Borgenvik TL, Karlsvik TM, Ray S, Fawzy M, James N. Blue 

 nevus-like and blue nevus-associated melanoma: a compre-

hensive review of the literature. ANZ J Surg. 2017 May;87(5): 

345-349. doi: 10.1111/ans.13946. Epub 2017 Mar 20. PMID: 

28318130.