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Pathology of Combined Nevus:

"Two or more different types of Melanocytic Nevi in a single lesion."

Dr Sampurna Roy MD               




This lesion is characterised by a combination of Acquired Melanocytic Nevus or Spitz nevus with Blue Nevus or Congenital Nevus.

Clinically, combined nevi present as well circumscribed hyperpigmented spots surrounded by less pigmented areas.  

Microscopic features:

1. 2.  3. 4. 5.

Microscopic Images of  1. Acquired Melanocytic Nevus  2. Blue Nevus  3. Congenital Nevus  4. Deep Penetrating Nevus  5. Spitz Nevus

In Combined Nevus there is a mixed cellular pattern.

Histologically, two pigmented melanocytic lesions are usually present in distinct areas or may be closely intermingled.

These lesions may simulate melanoma by being asymmetrical and  displaying prominent irregular pigmentation. 

Microscopically, one variant reveals epithelioid and spindle cells of Spitz nevus together with dysplastic nevus. 

In another variant there are small melanocytes with large balloon cells, simulating balloon cell melanoma. 

It is not at all uncommon to see a very small  component of non-blue nevus in a cellular blue nevus or deep penetrating nevus.


Unlike melanoma, there is no evidence of pagetoid intraepidermal spread.

Further reading:

Histologic classification of the combined nevus: analysis of the variable expression of melanocytic nevi

Plaque type blue nevus combined with lentigo (nevus spilus)

Association of nevus sebaceus with an unusual type of "combined nevus"

The histologic spectrum of pigmented spindle cell nevus: a review of 120 cases with emphasis on atypical variants

Ocular combined nevus: report of a case of scleral blue nevus associated with a choroidal nevus

Malignant combined nevus

Agminate-type combined nevus consisting of a common blue nevus with a junctional Spitz nevus

A case of combined nevus: compound nevus and spindle cell Spitz nevus.

Dermoscopic evolution of a congenital combined nevus in childhood

Combined nevi of the oral mucosa

Combined nevi of the conjunctiva

Combined naevus: a benign lesion frequently misdiagnosed both clinically and pathologically as melanoma





Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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