Pigment International

: 2021  |  Volume : 8  |  Issue : 3  |  Page : 173--175

Bilateral nevus of Ota: unique presentation

Pallavi Hegde1, Rashmi Sarkar2,  
1 Senior Resident, Department of Dermatology, Venereology, Leprosy, Kasturba Medical College and Hospitals, Manipal, Karnataka, India
2 Department of Dermatology, Venereology, Leprology, Lady Hardinge Medical College, New Delhi, India

Correspondence Address:
Dr. Rashmi Sarkar
Department of Dermatology, Venereology, Leprology, Lady Hardinge Medical College, New Delhi


Nevus of Ota (NOO) is a dermal melanocytoses characterized by bluish-brown macules along the distribution of trigeminal nerve. Ocular involvement is observed in most of the patients in the form of scleral pigmentation. Also reported associations in this condition are iris/ciliary body pigmentation/glaucoma, ocular melanoma, etc. Hence, the terms nevus fusco-ceruleus ophthalmo-maxillaris and oculodermal melanocytosis are used to refer to this condition. Bilateral NOO is a rarely encountered condition, with only few scattered case reports in the literature. In this study, we report a rare presentation of bilateral NOO in four patients. The condition is important to recognize due to cosmetic concern it poses and limited treatment options.

How to cite this article:
Hegde P, Sarkar R. Bilateral nevus of Ota: unique presentation.Pigment Int 2021;8:173-175

How to cite this URL:
Hegde P, Sarkar R. Bilateral nevus of Ota: unique presentation. Pigment Int [serial online] 2021 [cited 2022 May 26 ];8:173-175
Available from: https://www.pigmentinternational.com/text.asp?2021/8/3/173/330895

Full Text


Nevus of Ota (NOO) is a dermal melanocytosis characterized by bluish-brown colored macules along the distribution of trigeminal nerve. Also observed in this condition is the ocular involvement in the form of scleral pigmentation, present in most of the patients. Hence, the synonyms nevus fusco-ceruleus ophthalmo-maxillaris and oculodermal melanocytosis are used to refer to this condition. In this study, we report a rare presentation of bilateral NOO in four patients.


Case 1

A 18-year-old female patient presented to the dermatology department with a history of dark-colored lesion on both cheeks since birth. On examination, ill-defined, bluish-brown colored macules were present over bilateral cheeks extending up to the temples and forehead [Figure 1]. Similar bluish discoloration was noted on the right side of hard palate.{Figure 1}

Case 2

A 22-year-old female patient presented with similar dark colored lesion as in case 1 which was present since her childhood. Examination revealed bluish-black colored macules on bilateral cheeks extending till temples and forehead [Figure 2]. This patient also showed scleral pigmentation as in case 1 and demonstrated bluish lesion at the middle of hard palate.{Figure 2}

Case 3

A 21-year-old male patient presented with a complaint of similar lesion but only on the left side of the cheek since birth. On examination, bluish-black macules were noted on left cheek, extending to the left-side nose [Figure 3]. On further examination, scleral lesions were found to be bilateral and oropharyngeal mucosa was free of lesions.{Figure 3}

Case 4

A 13-year-old girl child was brought by her mother with a complaint of dark colored lesion over the face for the past 3 months. On examination, the patient demonstrated bluish-black macule over bilateral cheek and temples. Extensive scleral bluish discoloration was noted bilaterally [Figure 4]. Multiple bluish macules of similar morphology were present on the hard palate and gingival mucosa.{Figure 4}

Ophthalmology referral was performed in all the patients and all four of them were free of iris/uveal/choroidal/retinal pigmentary changes/nevi and malignancy. Systemic examination was within normal limits in all four patients. We were not able to perform the dermoscopic examination and skin biopsy could not be carried out as the patients denied the procedure for cosmetic reasons and few were lost to follow-up.


Bilateral NOO is a rare entity and constitutes around 5% cases of NOO.[1] Adequate history with specific emphasis on the onset of the lesion and examination of mucosa are crucial to differentiate it from acquired bilateral NOO-like macule (ABNOM). Few cases of bilateral NOO are reported from Indian population,[1],[2] few from other Asian population,[3],[4] and from western literature.[5] We hereby report four cases of bilateral NOO. One of our case was unique, the patient had unilateral skin involvement to present with, and careful examination revealed bilateral scleral involvement, very distinct from previously reported cases in the literature. Q switched Nd:YAG lasers are advised for the treatment of NOO. However, due to unavailability of this facility at our institute, cosmetic camouflage was advised. The closest differential diagnosis is ABNOM. The key differences between bilateral NOO and ABNOM entities are summarized in [Table 1], few of which helped us to diagnose NOO in our patients. Another close differential for NOO is melasma, which should be considered especially in a Southeast Asian female patient presenting in her middle age. The differences between the two entities are summarized in [Table 2].{Table 1}{Table 2}

Declaration of the patient consent

The authors certify that patients’ consent has been obtained for photographs, their details to be published, and patients understand that their identity/name will not be revealed.[7]

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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