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Case Reports

Abstract

Melanocytic nevi are common benign lesions with various subtypes categorized by histologic appearance. While prevalence is higher in younger individuals, characteristics of nevi in the elderly are less studied. A subset termed senescent nevi, exhibiting atypical cells, is emerging in this population. Our report presents a case of a senescent compound nevus of the elderly with atypical nuclei. Our patient was a 69-year-old woman who presented with a brown macule on her right central malar cheek, clinically resembling a benign melanocytic nevus or basal cell carcinoma. Biopsy revealed an asymmetric compound melanocytic proliferation with sun-damaged skin, showing atypical features including enlarged dermal melanocytes with hyperchromatic nuclei and pseudo-inclusions. Immunohistochemistry confirmed the diagnosis of a senescent intradermal nevus of the elderly, with negative PRAME and beta catenin, no expression of BRAF and NRAS, and retained expression of P16 and BAP1. In this case, our follow-up recommendations included close clinical monitoring or conservative re-excision due to limited data on recurrence rates. Since elderly individuals are more exposed to ultraviolet B radiation, they are prone to melanocyte senescence. Studies on nevi in this population reveal differences between senescent nevi and benign nevi, with atypical features including solar elastosis and intranuclear pseudo-inclusions. Hence, recognition of senescent nevi in the elderly is crucial to prevent misdiagnosis.