The Impact of Nevus of Ito

This blog series highlights conditions that have a strong impact on people of color and appears as part of Project IMPACT: Improving Medicine’s Power to Address Care and Treatment.

Nevus of Ito is a type of congenital dermal melanocytosis. It typically affects the posterior supraclavicular nerves and the lateral cutaneous brachial nerves of the shoulder. Affected individuals will typically present with a non-tender blue or gray patch or macule with a mottled or speckled appearance.

The pathophysiology of this condition has not been fully explained, but a leading hypothesis is that during embryogenesis, dermal melanocytes migrating from the neural crest fail to reach their final destination in the basal layer of the epidermis. Additionally, genetics are believed to play a significant role, as family history associations have been reported.

Nevus of Ito and all other congenital dermal melanocytoses are considered benign conditions; however, there have been a few cases of malignant transformation, particularly in affected White individuals.

 

How does nevus of ito impact people of color?

Nevus of Ito most commonly appears in darker-skinned individuals, particularly in those of Asian descent, but the true incidence of this benign condition has not been elucidated. Patients are usually first diagnosed in infancy or early adolescence.

WHY IS IT HARD TO SPOT OR MISDIAGNOSED? 

The color of the nevus may differ between different skin tones. It can appear light gray or brown in lighter skin, but it may appear brown-gray, violet, or blue-gray in darker skin.

 

What to look for:

Patients will present with a blue, brown, or blue-gray poorly demarcated patch in the deltoid, supraclavicular, or scapular regions of the body. If lesions are located outside of these areas, consider a different diagnosis within the family of congenital dermal melanocytoses. Biopsy of the skin will show melanophages and dark spindle-shaped dendritic melanocytes in the superficial dermis.

Although rare, there have been some instances of melanoma associated with nevus of Ito. These lesions tend to be fast-growing nodules that lack pigment and are typically palpable on physical exam.

 

Differential:

 

Treatment:

Due to the benign nature of this dermal melanocytosis, individuals do not always seek treatment. However, Q-switched and picosecond lasers have demonstrated efficacy in treating nevus of Ito. Of note, darker-skinned individuals may experience an increased risk of post-procedure hypo- or hyperpigmentation.

 

Sources

Agarwal, Prateek. and Bhupendra C. Patel. “Nevus Of Ota And Ito.” StatPearls, StatPearls Publishing, 25 July 2021.

Resende, Cristina et al. “Late onset Ito’s nevus.” BMJ case reports 2013 bcr2013009746. 30 May. 2013, doi:10.1136/bcr-2013-009746

“Nevus of Ito” Accessed November 2, 2021: https://www.visualdx.com/visualdx/diagnosis/nevus+of+ito?diagnosisId=52031&moduleId=101&usePassword

Tan, C et al. “Partial depigmentation arise in the naevus of Ito.” Journal of the European Academy of Dermatology and Venereology : JEADV 20,10 (2006): 1331-2. doi:10.1111/j.1468-3083.2006.01678.x

Badawi, A et al. “Behandlung des Naevus Ota und Ito und des Pigmentnävussyndroms” [Treatment of nevus of Ota and Ito and epidermal nevus syndrome]. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete 71,12 (2020): 926-931. doi:10.1007/s00105-020-04710-3

This Project IMPACT blog series was created to highlight dermatologic conditions that disproportionately affect people of color. By improving diagnosis in skin of color we can reduce racial disparities in healthcare.

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