Resolution and Recurrence of Vitiligo Following Excision of Congenital Melanocytic Nevus

Abstract

Vitiligo associated with halo congenital melanocytic nevus (CMN) is rare. There are limited reports in the literature, especially with regard to CMN excision. We present the case of a 5-year-old girl who presented with vitiligo of the periorbital and axillary regions and halo formation around CMN of the buttock. The lesion was excised, and all areas of vitiligo improved, but 18 months postoperatively, a halo of depigmentation appeared around the excision scar and later in the periorbital and axillary regions. In review of literature, there is only one report of excision of halo CMN and resultant improvement of vitiligo. Although initial resolution of vitiligo in this case was promising, the recurrence indicates that this complex process is not reliably controlled with excision of the inciting lesion.

Acrofacial vitiligo following halo formation around congenital melanocytic naevi

“…While for long it was believed that both share a common immunological mechanism of pigment destruction, recent studies point toward their separate pathogenic mechanism. [5] The support to the hypothesis comes from an observation made by Workman et al . [5] who reported a recurrence of vitiligo lesions after their initial regression on the complete removal of nevi.…”

“…[5] The support to the hypothesis comes from an observation made by Workman et al . [5] who reported a recurrence of vitiligo lesions after their initial regression on the complete removal of nevi. Other observations that support for different triggers for halo nevi and vitiligo are that while halo nevi always begin around a nevus, vitiligo rarely does so; a lymphocytic infiltrate is always present in halo nevus but is exceptional in lesions of vitiligo.…”

“…[2] Surgical excision may be attempted if the lesion is significantly irregular; its appearance is unstable characterized by a change in pigmentation, size or presence of ulceration; if the patient request removal due to cosmetic reasons. [5]…”

“…[57] A series by Stierman et al . [2] reviewed nine new patients and ten already reported patients from the literature.…”

Halo Nevus Arising from Congenital Melanocytic Nevus Featuring an Early Onset Vitiligo

“…Microstructural transformation and cellular injury progresses into multiple whitish patches after occurrence of halo nevus. van Geel et al [4] conjectured improvement in skin lesion after early surgical excision and Workman et al [15] observed initial improvement after excision of a halo nevus arising in congenital melanocytic nevus. However, elucidation must be supported through sufficient cases and studies.…”