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Case Reports

Abstract

Hormonal influences on melanocytic proliferations, including nevi and melanoma, are well documented in pregnancy and exogenous hormone therapy. However, reports describing such changes in the setting of gender-affirming hormone therapy are limited. We present a case of hormonally influenced melanocytic nevus in a transgender male on long-term exogenous hormone treatment. A 28-year-old transgender male presented with a slowly enlarging, pruritic and mildly tender scalp lesion, initially noted over a decade earlier and clinically considered a cutaneous acrochordon. The patient had been receiving medroxyprogesterone and testosterone cypionate since 2017. On examination, a 5 mm skin-colored papule was identified on the right superior occipital scalp. Biopsy revealed a lentiginous compound nevus with moderate atypia of the intraepidermal component without upward spread, confirmed by Melan-A immunostaining. The dermal component exhibited features favoring hormonal influence, including two melanocytic populations: (1) a predominant component of variably sized nevomelanocytes with maturation and (2) superficial dermal nests of smaller, monomorphic melanocytes positive for HMB-45 with a mildly increased Ki-67 proliferative index. PRAME was negative and BAP-1 expression was retained. These superficial nests resembled the “superficial micronodules” in pregnancy nevi previously described by Chan et al. This case illustrates alterations in a melanocytic nevus likely related to gender-affirming chronic hormone therapy and emphasizes the importance of clinicopathologic correlation when interpreting atypical changes in melanocytic lesions.