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November 1973

Malignant Blue Nevus

Author Affiliations

Needham, Mass

Arch Dermatol. 1973;108(5):726. doi:10.1001/archderm.1973.01620260070032

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To the Editor.—  The article by Dr. F. J. Hernandez (Arch Dermatol 107: 741, 1973) focuses attention on a difficult diagnostic problem in dermatopathology, the malignant blue nevus.The skin lesion that was described may indeed represent a primary malignant blue nevus. However, I think it would have been helpful if the author had discussed the alternative possibility that the lesion represented a metastatic nodule of melanoma rather than a primary malignant blue nevus.Cases of metastatic melanoma with no discernible primary cutaneous lesion are known to exist and are discussed by Sutton (Diseases of the Skin, St. Louis, CV Mosby Co Publishers, 1956, pp 1083-1088). From the histopathologic standpoint, malignant blue nevus and metastatic malignant melanoma to the skin are often indistinguishable. One must suspect a visceral primary tumor in cases of metastatic melanoma without an obvious primary cutaneous lesion. The involvement of the central nervous system in the case

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