The Impact of Nevus of Ota

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 Ota is an oculodermal pigmentation disorder that is commonly found in Asian and Black populations, with a 5:1 predominance in women compared with men. It is caused by the incomplete migration of dermal melanocytes along the first and second branches of the trigeminal nerve, which innervates the skin, eyes, and cranial structures. Patients typically present at birth with unilateral ocular pigmentation and less frequently with bilateral presentation. However, dermal melanocytosis may become apparent after puberty as the size and degree of discoloration increases with age and with exposure to infection, trauma, and UV light. Cutaneous melanoma and even central nervous system melanoma have been exceedingly rarely reported to develop in concert with nevus of Ota.

 

How does nevus of ota impact people of color?

Nevus of Ota is a facial dermal melanocytosis that may be present at birth or develop during puberty or adulthood. Despite the fact that nevus of Ota is more common in skin of color, there are very few laser trials and case reports in skin colors darker than Fitzpatrick skin phototype IV. However, efforts to improve laser treatment efficacy and safety in darker skin types have begun to take place. One study reported that 1064-nm Q-switched Nd:YAG laser treatment may be a suitable option for patients with skin phototype V who have nevus of Ota.

A similar study exploring the use of Q-switched laser treatment of nevus of Ota in children with phototypes IV-VI found that of the 24 children included, 70% reported 76%-100% improvement, while 86% reported 51%-100% improvement. The study also supported the safety and efficacy of Q-switch lasers in SOC, particularly in children.

 

What to look for:

Nevus of Ota is marked by mottled, gray-brown to blue-black patches surrounding regions of the eye, sclera, cornea, conjunctiva, extraocular muscles, and tympanic membranes. Histologically, the melanocytes show the greatest density within the dermis.

 

Differential:

Nevus of Ota should be distinguished from other congenital dermal melanocytic nevus of skin disorders such as congenital dermal melanocytosis (formerly known as Mongolian spot) and nevus of Ito, where similar pigmentation appears on the lower back and shoulder area respectively.

Hori nevus is characterized by multiple speckled brown, blue-brown, or slate-gray macules on the zygomatic region mainly in females. Hori nevi has more bilateral facial distribution, which is typically uncommon in nevus of Ota.

 

Diagnostic pearls:

Look for the presence of mottled bluish to gray ocular pigmentation unilaterally on the face with or without ocular pigmentation.

 

Treatment:

Laser therapy is the first line of treatment for nevus of Ota. Early intervention results in better therapeutic outcomes, reduced recurrence, and reduced adverse effects, such as scarring. There are many different types of lasers used to treat nevus of Ota, but picosecond alexandrite lasers have shown to have better clinical outcomes over Q-switched alexandrite lasers.

An ophthalmology referral is recommended given the association of nevus of Ota with elevated intraocular pressure and glaucoma, as well as uveal melanoma. Additionally, if the patient reports new-onset visual changes, headaches, emesis, swelling, or proptosis, refer to ophthalmology to screen for ocular melanoma.

Malignant transformation is extremely rare, but if there are new or atypical features, a biopsy may be considered. Ongoing monitoring by a dermatologist is also recommended, and patients should be instructed to return for any concerning changes within or around the nevus.

Sources

Achavanuntakul, Petchlada & Jantarakolica, Tatre. (2020). Early Treatment Initiation Improves Outcomes in Nevus of Ota: A 10-Year Retrospective Study SSRN Electronic Journal. 10.2139/ssrn.3754440.

Belkin DA, Jeon H, Weiss E, Brauer JA, Geronemus RG. Successful and safe use of Q-switched lasers in the treatment of nevus of Ota in children with phototypes IV-VI. Lasers Surg Med. 2018 Jan;50(1):56-60. doi: 10.1002/lsm.22757. Epub 2017 Nov 13. PMID: 29131366.

Chan HH, Kono T. Nevus of Ota: clinical aspects and management. Skinmed. 2003;2(2):89-98. doi:10.1111/j.1540-9740.2003.01706.x

Comparison of a picosecond alexandrite laser versus a Q-switched alexandrite laser for the treatment of nevus of Ota: A randomized, split lesion, controlled trial, Journal of the American Academy of Dermatology, Volume 83, Issue 2, 2020, Pages 397-403, ISSN 0190-9622, https://doi.org/10.1016/j.jaad.2019.03.016

Fusade T, Lafaye S, Laubach HJ. Nevus of Ota in dark skin–an uncommon but treatable entity. Lasers Surg Med. 2011;43(10):960-964. doi:10.1002/lsm.21121

Gupta G, Williams RE, Mackie RM. The labial melanotic macule: a review of 79 cases. Br J Dermatol. 1997;136(5):772-775.

Huang, L., Zhong, Y., Yan, T. et al. Efficacy and safety of 755 nm Q-switched Alexandrite Laser for Hori’s nevus: a retrospective analysis of 482 Chinese women. Lasers Med Sci (2021). https://doi.org/10.1007/s10103-021-03257-6

Pérez ME, Bley C, Cárdenas C. Nevus of Ota, a classic presentation. Med Clin (Barc). 2019;153(2):92. doi:10.1016/j.medcli.2018.09.021

Yiping Ge, Ying Yang, Lifang Guo, Mengli Zhang, Qiuju Wu, Rong Zeng, Huizhen Rong, Gaorong Jia, Hualing Shi, Jing Fang, Tong Lin, Comparison of a picosecond alexandrite laser versus a Q-switched alexandrite laser for the treatment of nevus of Ota: A randomized, split lesion, controlled trial, Journal of the American Academy of Dermatology, Volume 83, Issue 2, 2020, Pages 397-403, ISSN 0190-9622, https://doi.org/10.1016/j.jaad.2019.03.016.

 

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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