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Skin-Melanocytic tumors

Nevus of Ota

Author: Nat Pernick, M.D., PathologyOutlines.com, Inc.

Revised: 6 July 2009, last major update November 2008

Copyright: (c) 2005-2009, PathologyOutlines.com, Inc.

Definition

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● First described by Ota in 1939 (Tokio Med J 1939;63:1243)

● Uncommon hamartoma in periorbital and temporal skin

Terminology

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● Also called oculodermal melanosis

Epidemiology

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● Usually Orientals, also Hispanics, blacks, Native Americans

● 60% have lesions at birth, 87% female, 60% have dermal and ocular involvement (Indian J Dermatol Venereol Leprol 2008;74:125)

Clinical

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● Tends to persist and extend locally, becoming increasingly prominent with age, puberty and postmenopausal state

● Associated with ipsilateral glaucoma, intracranial melanocytosis; rarely with cutaneous, ocular or intracranial melanoma (Cutis 2008;82:25), vascular nevus (J Am Acad Dermatol 2008;58:88)

Types

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● Type IA: Mild orbital type: distribution over upper and lower eyelids, periocular and temple region
● Type IB: Mild zygomatic type: pigmentation in infrapalpebral fold, nasolabial fold and the zygomatic region
● Type IC: Mild forehead type: involvement of forehead alone
● Type ID: Involvement of ala nasi alone
● Type II: Moderate type: distribution over upper and lower eyelids, periocular, zygomatic, cheek and temple regions
● Type III: Involves scalp, forehead, eyebrow and nose
● Type IV: Bilateral

Reference: Tanino, Jpn J Dermatol 1939;46:435

● Hori’s nevus: acquired bilateral nevus of Ota-like macules (J Am Acad Dermatol 1984;10:961, Dermatol Online J 2005;11(4):1); usually Chinese women with family history, become more confluent and gray over time (Br J Dermatol 2006;154:50)

● Sun’s nevus: acquired unilateral nevus of Ota

Case reports

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● With iris melanoma (Surv Ophthalmol 2008;53:411)

● 47 year old light-skinned non-Asian woman (Dermatol Online J 2007;13(3):19)

● Bilateral with oral mucosa involvement (Indian J Dermatol Venereol Leprol 2002;68:104)

● Acquired Ito's nevus in Caucasian elderly woman (J Cutan Pathol 2007;34:640)

● Acquired bilateral nevus (Dermatol Online J 2005;11(4):1)

Treatment and prognosis

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● Cosmetic coverup products

● Multiple sessions of laser photothermolysis to avoid darkening and extension, beginning early after diagnosis (Dermatol Surg 2007;33:455)

● Combined skin abrasion and carbon dioxide snow method (Plast Reconstr Surg 1996;97:544); cryosurgery and microsurgery not recommended due to scarring; chemical bleaching not recommended due to depigmentation

Clinical description

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● Macule with irregular blue-gray pigmentation in distribution of 1st and 2nd division of trigeminal nerve

Clinical images

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Flat blue-gray pigmentation                             Acquired dark brown spots below eyes

with an irregular border

on the skin of lateral ocular areas                                

Bilateral acquired nevus of Ota like macules             Episcleral involvement

Micro description

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● Deeply pigmented dendritic melanocytes and melanophages dissecting bundles of dermal collagen in reticular dermis

Micro images

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Bipolar dendritic melanocytes in papillary and reticular dermis are arranged as single units between collagen bundles, also numerous pigment-laden macrophages

Other images: wavy dendritic cells with evenly dispersed melanin granules are distributed in the superficial reticular dermis

Additional references

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● eMedicine

End of Skin-Melanocytic Tumors > Nevus of Ota

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