Combined melanocytic nevi: histologic variants and melanoma mimics.

Combined melanocytic nevi are composed of 2 or more distinct populations of nevomelanocytes. Most commonly used to describe the combination of blue nevi with common nevi, it may also be applied to other combinations of benign melanocytic proliferations, including Spitz nevi and nevi with deep dermal pigmented nevomelanocytes. We report the incidence and distribution of these tumors at the Massachusetts General Hospital over the past decade and review guidelines for diagnostic criteria and nomenclature. Between 2000 and 2010 we identified 511 cases of combined nevi, represented by 4 histologically distinct diagnostic categories: (1) blue nevus, (2) nevi with deep dermal pigmented nevomelanocytes (plexiform/deep penetrating, inverted type A/clonal), (3) Spitz or pigmented spindled cell nevus, combined with another type of nevus (usually common or dysplastic), and (4) other combinations including 2 or more nevus types. Nearly one fifth of these tumors displayed atypical features; atypia was observed more often in combined nevi with Spitz or deep pigmented elements (26 of 55, 47%, and 25 of 98, 26%, respectively) than in combined common and blue nevi (37 of 336, 11%). Clinical follow-up data were available for 83% of the patients with atypical combined nevi; none developed recurrence or metastasis with a mean follow-up of over 4 years.