Derm Dx: Blue mark on the face and eye

Nevus of Ota is a type of melanocytic birthmark affecting the face in distribution of the V1 and V2 trigeminal dermatomes and frequently extending to the sclera of the ipsilateral eye.Ota nevi occur mainly in more darkly pigmented individuals, especially...

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Nevus of Ota is a type of melanocytic birthmark affecting the face in distribution of the V1 and V2 trigeminal dermatomes and frequently extending to the sclera of the ipsilateral eye.

Ota nevi occur mainly in more darkly pigmented individuals, especially Asian and black patients. Women are more commonly affected than men. Most cases are present at birth or infancy, but there is a second peak of onset around puberty. The condition is not inherited. 

Ota nevi are caused by melanin-producing melanocytes in the dermis. When melanin is produced in the dermis, the overlying skin develops a blue-gray color. This contrasts to epidermal melanin, which appears as brown.

The Ota nevus usually appears as an irregularly demarcated and mottled blue patch on the face. It is usually unilateral and follows the distribution of the V1 and V2 branches of the trigeminal nerve. 

The most commonly affected regions are the forehead, malar cheek, earlobe, nose, temple and periorbital skin – about two-thirds of patients have ipsilateral sclera involvement.

Rarely, Ota nevi have been associated with ocular melanoma, and extremely rarely with cutaneous melanoma. 

On biopsy, an Ota nevus will demonstrate pigmented dendritic melanocytes distributed between the collagen bundles of the upper third of the reticular dermis. 

Diagnosis, Treatment & Prognosis     

Diagnosing a nevus of Ota is based on the clinical appearance of a blue to gray birthmark in the distribution of V1 and V2, which is either present in infancy or develops at puberty. 

There are several related conditions including nevus of Ito and Hori’s nevus. Nevus of Ito is also a blue-gray birthmark due to the presence of dermal melanocytes, but differs from nevus of Ota in distribution. Ito nevi are found on the skin overlying the supraclavicular, scalpular and deltoid regions.

Hori’s nevus (also called bilateral nevus of Ota-like macules) is a condition that develops in Asian female adults.  In this condition, blue-gray or brown-gray patches develop on the zygoma, forehead, upper outer eyelids or nose in a bilateral distribution. The eye is not involved, unlike with Ota nevi.

Nevus of Ota (and related conditions) may be treated with Q-switched alexandrite, ruby or ND:YAG lasers. 

Since the most common associated malignancy is ocular melanoma, follow-up with an ophthalmologist at regular intervals is recommended for some patients.

Adam Rees, MD, is a graduate of the University of California Los Angeles School of Medicine and a resident in the Department of Dermatology at Baylor College of Medicine in Houston.