Current Challenges in Deciphering Sutton Nevi—Literature Review and Personal Experience

Abstract

Halo nevi, known as leukoderma acquisitum centrifugum, Sutton nevus, leukopigmentary nevus, perinevoid vitiligo, or perinevoid leukoderma, together with vitiligo and melanoma-associated hypopigmentation, belong to the group of dermatoses designated as immunological leukodermas. The etiology and pathogenesis of halo nevi has not been fully elucidated. There are several mechanisms through which a lymphocytic infiltrate can induce tumoral regression. In this review, we aimed to update the knowledge about Sutton nevi starting with the clinical appearance and dermoscopic features, continuing with information regarding conventional microscopy, immunohistochemistry, and the immunological mechanisms responsible for the occurrence of halo nevi. We also included in the article original unpublished results when discussing dermoscopic, pathologic and immunohistochemical results in halo nevi. Sutton nevi are valuable models for studying antitumor reactions that the human body can generate. The slow and effective mechanism against a melanocytic skin tumor can teach us important lessons about both autoimmune diseases and anticancer defenses.

The delicate relation between melanocytes and skin immunity: A game of hide and seek

“…The size of the halo can vary from 0.5 to 5 cm being influenced by the diameter of the nevus. A possible explanation for the halo is the hypothesis that radial deposited melanocytes around the naevus have the same antigen expression as the naevoid melanocytes ("melanocyte antigenic unit") (Nedelcu et al, 2021). Histopathological examination reveals a dense band-like lymphohistiocytic infiltrate with a predominance of CD8 lymphocytes being positive for CD69, GZMB, perforin, and Fas ligand.…”

“…Repigmentation is characteristic for stage IV. This process can take up years and in many cases, halo naevi get stuck in one of the stages without further evolution (Nedelcu et al, 2021). The size of the halo can vary from 0.5 to 5 cm being influenced by the diameter of the nevus.…”

Halo Nevi in the Pediatric Population

“…Dermoscopy, a noninvasive, bedside technique of examining cutaneous lesions with a dermatoscope, can assist in evaluating and diagnosing halo nevi. On dermoscopic evaluation of a halo nevus, the central nevus may show a globular, homogenous, or reticular pigment pattern—features commonly seen in other benign nevi in pediatric patients—and the surrounding hypopigmented ring is generally pale, homogenous, symmetric, and well circumscribed and does not contain any significant structures or features (Figure 1; Haliasos et al, 2013; Kolm et al, 2006; Nedelcu et al, 2021).…”

Optical Super-high Magnification Dermoscopy Findings of Halo Naevus

“…Halo naevi are found in approximately 1% of young adults, with no sex predilection. The 2 most common sites for their development are the trunk, followed by the scalp ( 2 ).…”