Angiotropic Neonatal Congenital Melanocytic Nevus: How Extravascular Migration of Melanocytes may Explain the Development of Congenital Nevi

In the following report we describe a medium-sized congenital melanocytic nevus (CMN) on the upper back of a female patient biopsied at 9 days of age. This case is a unique variant of CMN occurring in the neonatal period that mimics malignant melanoma. This is not only because of histologic features such as a large round or ovoid cellular phenotype of melanocytes mimicking melanoma cells but also because of conspicuous angiotropism, a finding not previously reported in such CMN. Immunostaining for blood and lymphatic vessels demonstrated angiotropism of melanocytes about blood vessels but not lymphatics. We have already emphasized the significance of angiotropism as a marker of extravascular migratory metastasis (EVMM) of melanoma. EVMM, a process by which tumor cells migrate along vessels and other tracks, has striking parallels with the migration of embryonic stem cells from the neural crest. Thus we propose, because angiotropism is a common finding in CMN and metastatic melanoma, that (1) such pathways of cellular migration may result in the genesis of CMN and other melanocytic neoplasms; and (2) the dysregulation of such embryonic pathways may result in the retrograde migratory phenomena of melanoma as already described. In summary, extravascular cellular migration of melanocytes seems to be fundamental for melanoma (perhaps other cancer) metastasis but also hypothetically may be important for the development of other melanocytic lesions such as CMN and requires further investigation.