Spitz nevus: a case report and the use of dermoscopy

The Spitz nevus is a benign melanocytic lesion with clinical and histopathological features similar to those of melanoma. It was first described in 1948 but great controversy still remains today with respect to its diagnosis and management. The use of dermoscopy may increase diagnostic accuracy. In Spitz nevus, the most common dermoscopic finding is a starburst-like pattern, followed by globular and atypical patterns. Diagnosis must be confirmed by histopathology, particularly in atypical cases.     

The local recurrence of pigmented Spitz nevus after removal

A seventeen-month-old female had a pigmented nodule on her left lower leg. The excised lesion was histologically diagnosed as a Spitz nevus, composed mainly of spindle-shaped melanocytes containing large amounts of melanin pigment. When nodular regrowth was seen at the operative site, the recurrent lesion was radically excised as nodular melanoma. However the histological characteristics of the second excised specimen were essentially the same as those in the initially excised one except for the existence of the newly formed collagen fibers, which may suggest an involuting stage in the central portion of the lesion.     

结缔组织增生性Spitz痣和色素性梭形细胞痣临床及组织病理学特征

目的:分析结缔组织增生性Spitz痣和色索性梭形细胞痣的临床及组织病理学特点.方法:回顾性分析确诊的8例结缔组织增生性Spitz痣和9例色素性梭形细胞痣患者的临床和组织病理学特征.结果:结缔组织增生性Spitz痣表现为梭形或上皮样痣细胞增生并伴有显著的胶原硬化和均质化,色素性梭形细胞痣表现为真、表皮交界处梭形细胞增生并伴有纤细的色素颗粒沉积.结论:结缔组织增生性Spitz痣和色素性梭形细胞痣是Spitz痣中较少见的特殊类型.其中色素性梭形细胞痣需要与黑素瘤相鉴别.     

Morphologic changes of acquired melanocytic nevi with eccentric foci of hyperpigmentation ("Bolognia sign") assessed by dermoscopy

BACKGROUND: Melanocytic nevi with eccentric foci of hyperpigmentation ("Bolognia sign") can be considered as a melanoma-simulating type of acquired melanocytic nevus. We report on the morphologic changes of this type of melanocytic nevus over a 39-month period of dermoscopic follow-up. OBSERVATIONS: A 5-year-old girl had a 4-mm brown papule with a peripheral blue-black area on her right upper arm. The eccentric focus of the hyperpigmentation corresponded dermoscopically to a blue-gray area of pigmentation associated with irregular brown-black globules or dots and partially with a superficial black network. After 39 months, a globular type of acquired melanocytic nevus was detectable, which clinically and dermoscopically appeared to be completely benign. A nearly identical situation was observed in 5 other melanocytic nevi, underlining the involution of the pigmented foci in these nevi. The histopathologic diagnoses of 2 lesions were consistent with a compound type of acquired melanocytic nevus with eccentric foci of hyperpigmentation. CONCLUSIONS: Dermoscopy allows identification of a morphologic pathway of modifications, probably typical for this type of melanocytic nevus in children, and therefore enables avoidance of surgical excision with attendant hypertrophic scarring in children. Conversely, in adults, when dermoscopic follow-up of melanocytic nevi reveals eccentric foci of hyperpigmentation, surgical excision of the lesion is indicated.     

Angiomatoid Spitz nevus: a distinct variant of desmoplastic Spitz nevus with prominent vasculature

Five cases of a distinctive variant of desmoplastic Spitz nevus are reported. To the best of our knowledge, this tumor has never been described previously. Clinically, it presents itself as a solitary papule on the extremities of young adults. Microscopically, it shows predominance of solitary melanocytes with epithelioid appearance over cell nests. They are embedded in a prominent fibrous stroma with many densely arranged, small blood vessels with plump endothelia not seen in other Spitz nevi. Because of its resemblance to a vascular tumor, the name angiomatoid Spitz nevus is proposed for this lesion. Absence of recurrences or metastases after complete excision in all cases supports the benign nature of the tumor.     

Pigmented spindle cell nevus and pigmented Spitz nevus--clinical and histopathological study on pigmented Spitz nevus, and its differentiation from early melanoma by fluorescence method and measurement of 5-S-CD level in the lesion

On the basis of clinical and histopathological studies on 17 patients who had been diagnosed as having pigmented Spitz nevus (PSN), pigmented spindle cell nevus (PSCN) was surmised to be a type of pigmented Spitz nevus. In order to distinguish pigmented spindle cell nevus and pigmented Spitz nevus from early melanoma, 5 PSCN cases and 12 PSN cases were analyzed by the fine-needle aspiration fluorescence method, touch fluorescence method and measurement of the 5-S-CD level in the lesion. With the touch fluorescence method, fluorescent tumor cells were detected in one case of PSN. With the fine-needle aspiration fluorescence method, fluorescent tumor cells were detected in one PSCN case and 2 PSN cases. In comparison with fluorescent melanoma cells, the detected fluorescent tumor cells were smaller in size and number and resembled melanocytes. The 5-S-CD level in the lesion was 50 ng/mg or less in all cases, whereas the level in melanoma is known to be a high 100 ng/mg or more. In the final analysis, measurement of the 5-S-CD level in the lesion was concluded to have the greatest utility for differential diagnosis of pigmented spindle cell nevus and pigmented Spitz nevus from early melanoma.     

皮肤镜表现为落日征的Spitz痣1例

 患儿,女,1 岁。左眉弓上方内侧结节半个月。皮肤科查体：左眉弓上方内侧有一个半球形的红色结节,大小约 0.8 cm×0.6 cm,表面破溃、浆液性渗出,边界清楚。皮肤镜检查示红色均质背景,周边有黄白色鳞屑,呈现“落日征”。组织病理表现为表皮角化过度并角化不全,表皮假上皮瘤样增生,局部表皮高度水肿,水疱形成,表面可见浆痂。局部表皮内及真皮全层大量上皮样细胞增生,局部围绕附属器排列,细胞形态尚温和,偶见核裂。免疫组化：HMB-45(部分弱+),Melan-A(-),S-100 （+）,Ki-67 （3%+）,CD163(-),CD68(-)。诊断：Spitz 痣。完整切除皮损,术后6个月随访,未见复发及转移。     

Pseudogranulomatous Spitz nevus: a variant of Spitz nevus with heavy inflammatory infiltrate mimicking a granulomatous dermatitis

Spitz nevus is a benign melanocytic proliferation that shows relatively characteristic clinicopathologic features. Despite this, Spitz nevus is clinically confused with many other lesions, and histopathologically it is sometimes difficult to distinguish it from melanoma. However, Spitz nevus rarely causes differential diagnostic problems with granulomatous dermatitis. This article describes an 8‐year‐old girl who presented with a nodule on her right arm, a clinical appearance of a pyogenic granuloma. Histopathologically, there was a dermal lesion composed of aggregates of large epithelioid cells surrounded by a heavy inflammatory infiltrate, mimicking a sarcoid‐like granulomatous dermatitis. Immunohistochemistry showed epithelioid cells with strong nuclear and cytoplasmic staining with S‐100 protein, thus establishing the diagnosis of a melanocytic tumor. The heavy T‐cell lymphocytic infiltrate that accompanies the large epithelioid cells caused its granulomatous appearance. Molecular assessment showed H27H mutation in the HRAS gene. We suggest the term ‘pseudogranulomatous’ for this variant of Spitz nevus because it indicates that the lesion is not authentically granulomatous and simply mimics a granulomatous dermatitis.     

发生在斑痣上的Spitz痣5例

报告5例发生在斑痣上的Spitz痣,其中1例位于下肢,4例位于面部.5例患者临床均表现为在斑痣上出现的红色或褐色丘疹,组织病理检查均为Spitz痣.     

Spitz nevus: a case report.

The case of a 2-mm Spitz nevus is reported. We comment on the case and describe the skin-surface microscopy features.     

Acral pigmented Spitz nevus in a child with transepidermal migration of melanocytes: Dermoscopic and reflectance confocal microscopic features

Acral pigmented Spitz nevi are seldom reported in the literature. We report a new case on the palm of a 4‐year‐old girl that demonstrated correlation between features observed on dermoscopy and reflectance confocal microscopy (RCM). Histopathology revealed a benign intraepidermal Spitz nevus with transepidermal elimination of melanocytes that showed on RCM as focal atypical bright cells concerning for malignancy. This case is one of few reports in the literature combining dermoscopy, reflectance confocal microscopy, and histology for an acral Spitz nevi, which are rarely evaluated by RCM given the thickness of the stratum corneum in acral sites.     

非典型Spitz痣一例

患者女,45岁,左下肢近踝部出现暗红色孤立肿物5个月,无明显主观症状,近1月余生长迅速。患者既往体检,无系统疾病及恶性肿瘤病史,家族中无恶性肿瘤病史……     

血管瘤样Spitz痣一例

患者女,4岁,因鼻背部红色丘疹8个月就诊。患者8个月前无明显诱因下鼻背部出现粉色丘疹,无自觉症状,逐渐增大。体检：一般情况可……