Maturing papillomatous nevoid melanoma in the scalp mimicking recurrent melanocytic nevus: A case report of previously undescribed subtype of nevoid melanoma

• Published in: Pathology international Vol. 72; no. 1; pp. 59 - 64
• Main Authors: Tsujimura, Marina, Kaku, Yo, Takeuchi, Yasuhide, Ishida, Yoshihiro, Fujimoto, Masakazu, Usui, Shunya, Yamada, Yosuke, Ogawa, Seishi, Shea, Christopher R., Haga, Hironori
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.01.2022
• Subjects: Case reports; CDKN2A; Diagnosis; Diagnosis, Differential; Female; Gene deletion; Histology; Humans; Immunohistochemistry; Lesions; maturation; Melanocytes; Melanocytes - pathology; Melanoma; Melanoma - diagnosis; Melanoma - pathology; Melanoma, Cutaneous Malignant; Middle Aged; Mimicry; Mutation; nevoid melanoma; Nevus; Nevus, Pigmented - diagnosis; Nevus, Pigmented - pathology; Papilloma - pathology; papillomatous; Scalp; Scalp - pathology; Skin Neoplasms - diagnosis; Skin Neoplasms - pathology; whole‐exome sequencing; maturation; CDKN2A; nevoid melanoma; papillomatous; whole-exome sequencing
• ISSN: 1320-5463; 1440-1827
• DOI: 10.1111/pin.13178

Nevoid melanoma is a subtype of melanoma that histologically resembles a melanocytic nevus. Two subtypes have been proposed for nevoid melanoma, namely papillomatous and maturing. Here, we report the case of a 67‐year‐old woman who developed two nevoid melanomas on her scalp with composite histological features of papillomatous and maturing subtypes after electrocautery of a nearby solitary scalp papule. The histology of both lesions was very similar, papillary in shape, and both comprised two melanocyte populations, including large atypical melanocytes and small non‐atypical melanocytes. Whole‐exome sequencing was performed in one of the two lesions, which revealed a high mutation burden (17 mutations/megabase) with co‐deletion of CDKN2A. Additional immunohistochemistry revealed that the large and small melanocytes in both lesions were completely negative for p16 and MTAP. A final diagnosis of nevoid melanoma was made. To our knowledge, this is the first report of a nevoid melanoma with both features of papillomatous and maturing subtypes. Pathologists should be aware of this subtype of melanoma to avoid misdiagnosis as a mitotically active melanocytic nevus. In this case, immunohistochemistry for p16 and MTAP, in addition to molecular analysis, helped in the final diagnosis.