Regressing eruptive disseminated pigmented Spitz (Reed) nevi in a young adults

Abstract Eruptive disseminated Spitz nevi is a rare clinical presentation that features an abrupt widespread eruption of Spitz nevi. Spontaneous regression of these nevi has been rarely reported in previous literature. The authors of the present study report the case of a 30-year-old man who presented eruptive disseminated Spitz nevi that appeared within a week and started regression in the following years.

Recurrence of melanoma in the scar after excised Spitz nevus in a 17-year-old child

Abstract Melanoma in childhood is rare and its diagnosis is more difficult than in adults, as it often presents histologic features overlapping with the Spitz nevus. The authors report the case of a 17-year old boy who was first diagnosed with Spitz nevus, however, the final diagnosis made after the excision of the tumor arising in the scar was changed to melanoma. The case in this present study emphasizes the importance of the differential diagnosis of skin tumors in young patients.

Nevus azul celular con satelitosis y velo azul blanquecino simulando un melanoma, a propósito de un caso / Cellular blue nevus with satellitosis and blue veil whitish simulating a melanoma, purpose of a case

Los nevi azules son proliferaciones melanocíticas dendríticas benignas a nivel dérmico, congénitos o adquiridos, debido a un defecto migratorio embrionario de melanocitos a partir de la cresta neural. Se manifiestan clásicamente como una pápula, nódulo o placa de color azul o azul-gris. Muchos subtipos histológicos se han descrito, siendo los más comunes el nevus azul común, nevus azul celular y nevus azul combinado. Las formas esporádicas incluyen al nevus azul lineal, eruptivo, agminado y con satelitosis. La dermatoscopía característica muestra un patrón de pigmentación homogéneo monocromático azul o azul-grisáceo, con ausencia de otras estructuras. Sin embargo, se han descrito también patrones de pigmentación dicromáticos y multicromáticos, además de estructuras tales como red de pigmento, puntos, glóbulos, proyecciones radiadas, pseudópodos, áreas cicatriciales blanquecinas, patrón vascular y rosetas. El diagnóstico diferencial de los nevi azules incluye lesiones melanocíticas y no melanocíticas, benignas y malignas, destacando entre ellas el melanoma. Se presenta el caso de un paciente de sexo masculino de 30 años, portador de un nevus azul celular con cambios de rápida evolución, con desarrollo de lesiones satélites y un aspecto dermatoscópico sugerente de malignidad, simulando un melanoma.

Blue nevi are benign, congenital, or acquired, dermal dendritic melanocytic proliferations due to an embryonic migratory defect of melanocytes starting from the neural crest. They classically manifest as a blue or blue-gray papule, nodule, or plaque. Many histological subtypes have been described, including common blue nevus, cellular blue nevus and combined blue nevus. Sporadic forms include linear blue nevus, eruptive, agminate and with satellitosis. Characteristic dermoscopy shows a homogeneous monochromatic blue or steel-blue pigmentation pattern, with the absence of other structures. However, dichromatic and multichromatic pigmentation patterns have also been described, in addition to structures such as pigment network, dots, globules, streaks, pseudopods, whitish scar areas, vascular pattern and rosettes. Differential diagnosis of blue nevi includes melanocytic and non-melanocytic, benign and malignant lesions, most notably melanoma. The case of a 30-year-old male patient is presented, with a cellular blue nevus with rapidly evolving changes, with development of satellite lesions and a dermoscopic appearance suggestive of malignancy, mimicking melanoma.

Spitz nevus and infliximab: association or coincidence?

Abstract Biological therapies, including anti-TNF agents, are important in the treatment of various chronic inflammatory diseases, including psoriasis, rheumatoid arthritis or inflammatory bowel disease. The increased use of these drugs translates into an increasing awareness of its adverse effects, which include malignancy. In this paper, we describe the case of a 28-year-old woman who developed a spitzoid melanocytic tumor after starting infliximab therapy for ulcerative colitis. The evidence for causality between anti-TNF and melanocytic proliferations is still sparse; nonetheless, treatment-associated immunosuppression seems to play a key role in this phenomenon. Therefore, a regular follow-up with a rigorous skin examination is essential in these patients. Noninvasive techniques such as dermoscopy or reflectance confocal microscopy are particularly useful diagnostic tools in these circumstances.

Eruptive disseminated Spitz nevi - Case report

Abstract Spitz nevus is a benign melanocytic lesion, which presents in several ways: solitary, agminated, or disseminated. The disseminated variant is uncommon; it may have a rapid evolution (the eruptive form) and be difficult to manage. This report presents the case of a 24-year-old patient with multiple papules on his limbs, which had appeared four years previously. On physical examination, 120 pink and skin-colored papules were seen, which under dermoscopy were observed to be homogeneous, pink vascular lesions. Histopathologic study revealed epithelioid cells arranged in groups or singly in the dermis and dermo-epidermal junction. They were HMB-45 positive in the superficial dermis, and Ki-67 < 1%. Given these findings, a diagnosis of eruptive disseminated Spitz nevi was made.

Neoplasias melanocíticas spitzoides: estudio clínico-histopatológico de 62 lesiones en un hospital universitario chileno / Spitzoid melanocytic neoplasms: clinical-histopathological study of 62 lesions in a Chilean university hospital

INTRODUCCIÓN: Las neoplasias spitzoides son tumores melanocíticos con un espectro biológico variable, que constituyen un desafío diagnóstico. Los estudios en población latinoamericana son muy escasos, no contando con series chilenas. OBJETIVO: Caracterizar clínica e histopatológicamente a los pacientes con neoplasias spitzoides en el Hospital Clínico de la Universidad de Chile. METODOLOGÍA: Estudio retrospectivo, basado en revisión de fichas clínicas y biopsias de pacientes con diagnóstico confirmado de nevo de Spitz (NS), tumor de Spitz atípico y melanoma spitzoide, entre 1995-2018. Se analizó: edad, sexo, características clínicas e histopatológicas. RESULTADOS: Se estudiaron 62 neoplasias spitzoides. 39 mujeres (62,9%). Edad promedio de 18,9 (+14,3) años. Localización de lesiones: 8 (12,9%) cabeza, 6 (9,7%) tronco, 17 (27,4%) extremidades superiores y 22 (35,5%) extremidades inferiores; en 9 (14,5%) no se registró. Tamaño promedio 5,5 mm. Respecto al diagnóstico clínico: 21 (33,9%) nevo melanocítico, 16 (25,8%) nevo atípico, 12 (19,4%) NS, 7 (11,3%) lesiones vasculares, 3 (4,8%) melanoma y 3 (4,8%) otro. En cuanto al diagnóstico histopatológico: NS clásico 38 (61,3%), Nevo de Reed 9 (14,5%), NS desmoplásico 2 (3,2%), NS atípico 8 (12,9%) y melanoma spitzoide 5 (8,1%). CONCLUSIÓN: El presente estudio constituye la primera serie chilena de neoplasias spitzoides, según la literatura revisada. Destaca el mayor número de lesiones en mujeres y en extremidades, lo que ya había sido informado en otras series similares. Considerando la dificultad en el diagnóstico clínico preoperatorio, destaca un número mayor de sospecha de neoplasias spitzoides comparado a otros estudios.

INTRODUCTION: Spitzoid neoplasms are melanocytic tumors with a variable biological spectrum, which are a diagnostic challenge. There are few studies in Latin American population, not finding chilean series. OBJECTIVE: Clinically and histopathologically characterize patients with spitzoid neoplasms in the Hospital Clínico Universidad de Chile. METHODOLOGY: Retrospective study, based on re-view of clinical records and biopsies of patients with confirmed diagnosis of Spitz nevus (SN), atypical Spitz tumors and spitzoid melanoma (SM), between 1995-2018. It is analyzed: age, sex, clinical and histopathological characteristics. RESULTS: 62 spitzoid neoplasms were studied. 39 women (62.9%). Average age of 18.9 (+14.3) years. Location of injuries: 8 (12.9%) head, 6 (9.7%) trunk, 17 (27.4%) upper extremities and 22 (35.5%) lower extremities; in 9 (14.5%) it is not identified. Average size 5.5 mm. Clinical diagnosis: 21 (33.9%) melanocytic nevus, 16 (25.8%) atypical nevus, 12 (19.4%) NS, 7 (11.3%) vascular lesions, 3 (4.8%) melanoma and 3 (4.8%) other. Histopathological diagnosis: classic NS 38 (61.3%), Reed Nevus 9 (14.5%), desmoplastic SN 2 (3.2%), atypical SN 8 (12.9%) and SM 5 (8.1%). CONCLUSION: The present study appears in the first chilean series of spitzoid neoplasms, according to the literature reviewed. It highlights the greatest number of injuries in women and in the extremities, which had already been reported in other similar series. In the preoperative clinical diagnosis, a greater number of suspicion of spitzoid neoplasms stands out compared to other studies.

The first case of vaginal angiomatoid Spitz nevus causing vaginal bleeding

Angiomatoid Spitz nevus is a variant of melanocytic nevus with prominent vasculature. Due to its pathologic features, angiomatoid Spitz nevus in the vaginal wall is extremely rare. A 42-year-old woman presented to the hospital with abnormal vaginal bleeding. Vaginal examination revealed a 2×2-cm well-demarcated tumor on the posterior wall of the vagina. The mass was successfully removed by complete excision and was diagnosed as angiomatoid Spitz nevus on pathologic examination. We present the first reported case of vaginal angiomatoid Spitz nevus, which caused vaginal bleeding. Although angiomatoid Spitz nevus has many histopathological similarities with malignant melanoma, precise histopathological diagnosis is important for preventing overtreatment.

A rápida evolução clínica de um nevo de spitz: acompanhamento de três anos em criança / The fast clinical evolution of a spitz nevus: three-year follow-up of a child

RESUMO Objetivo: Descrever a evolução clínica do nevo de Spitz, desde sua característica inicial plana até o aparecimento de uma superfície irregular, nodular e avermelhada e a conduta perante essas alterações. Descrição do caso: Criança do sexo feminino, fototipo II, com um pequeno nevo congênito na perna esquerda e outros pequenos nevos adquiridos. Paciente passou por avaliações anuais clínicas e dermatoscópicas para controle entre 3 e 7 anos de idade, quando um desses nevos, localizado na coxa esquerda, apresentou crescimento rápido. A hipótese clínica foi nevo de Spitz, com indicação de remoção cirúrgica com margem de segurança e posterior análise anatomopatológica. Considerando a idade da paciente e os aspectos clínicos e histológicos, a lesão foi diagnosticada como nevo de Spitz. Comentários: Uma lesão de padrão dermatoscópico globular e menor que 5 mm permitia acompanhamento clínico, porém a hipercromia, a estética local, o crescimento rápido, a possibilidade de trauma na região e os riscos de transformação maligna na puberdade nortearam a decisão de remoção total e posterior acompanhamento para monitorar qualquer recidiva.

ABSTRACT Objective: To report the clinical evolution and handling of a Spitz nevus, from its initial flat feature to becoming an irregular, nodular, reddish lesion. Case description: Female child, phototype II, with a small congenital nevus on the left lower limb and other sustained small nevi. The patient went through annual clinical and dermoscopic evaluations between the ages of three and seven, period during which the nevi located on the left thigh grew rapidly. The clinical hypothesis was Spitz nevus, with indication of surgical removal with a safety margin and anatomopathological study. Considering patient's age and clinical/histological aspects, the diagnosis of Spitz nevus was confirmed. Comments: Initial globular pattern and size under 5 mm upon dermoscopy allowed clinical follow-up. However, onset of hyperchromia and rapid growing of the lesion, along with aesthetic concerns, possibility of trauma in the region, and risk of malignancy at puberty guided the decision of total resection and follow-up for recurrence.

Nevo de Spitz en la infancia: el gran simulador de melanoma / Spitz nevus in childhood: the great melanoma simulator

El melanoma infantil ha aumentado su incidencia en los últimos años. Clínicamente suele presentarse como como una lesión amelanótica o con escaso pigmento, sobreelevada, en ocasiones sangrante. El principal diagnóstico diferencial se plantea con lesiones banales, y en ocasiones con lesiones melanocíticas como el nevo de Spitz/Reed. El nevo de Spitz se caracteriza por ser una pápula redondeada, solitaria, color piel topografiada en cara o extremidades. El nevo de Reed se presenta como un tumor plano o sobreelevado, oscuro, más frecuentemente en miembros inferiores. El tratamiento del mismo depende de la edad del paciente. En menores de doce años con lesiones típicas, suele tomarse una conducta expectante, mientras que si estas lesiones aparecen luego de esta edad se recomienda la exéresis, ya que podría tratarse de un melanoma.

The incidence of pediatric melanoma has been increasing. The most frequent clinical presentation is amelanotic lesions, lacking pigmentation and usually elevated, sometimes bleeding. Differential diagnosis includes benign lesions and may also include melanocytic lesions such as Spitz/Reed nevi. Spitz nevus usually presents as a solitary, rounded or oval papule, skin coloured, mainly affecting the face or limbs. Reed nevus is characterized by a dark tumor plane or elevated, often affecting the lower limbs. The treatment of these nevi depends on the patient´s age. Children under 12 years old with a typical lesion may undergo clinical and dermoscopic follow-up. In older patients, excision is recommended due to the probability of melanoma.

A Case of Hyalinizing Spitz Nevus: A Rare Variant in the Spectrum of Spitz Nevus / 대한피부과학회지

Hyalinizing Spitz nevus was first introduced in 1994 by Suster. It is considered a rare variant in the spectrum of Spitz nevus, with only a dozen cases having been reported to date. Herein we report a case of a 28-year-old Korean woman who had a brown papular lesion on the left palm, which was diagnosed as hyalinizing Spitz nevus. Upon histopathological investigation, discohesive growth patterns of nevus cells in a hyalinized stroma were noted. Immunohistochemical stains showed positive reactivity of nevus cells with S-100 protein and vimentin, but negative stains with HMB-45 and CD68. This case demonstrates a rare variant of Spitz nevus located on an unusual site, and calls for awareness in the diagnosis of cutaneous lesions that histologically exhibit a prominent hyalinized stroma.

Spitz Nevus with Atypical Clinical Features in a Baby / 대한피부과학회지

No abstract available.

Differentiation of Desmoplastic Spitz Nevus from Similar Conditions / 대한피부과학회지

No abstract available.

Polypoid Spitz Nevus: Aided by Dermoscopic Examination / 대한피부과학회지

Spitz nevus is a benign melanocytic nevus, common in children or young adults, and it has histological features that are confused with those of malignant melanoma. Polypoid Spitz nevus is the benign counterpart of polypoid malignant melanoma. A 22-year-old woman presented with a solitary 1.5×1.5 cm-sized firm polypoid erythematous nodule on the left thigh. On dermoscopy, pink to yellowish lagoons intermingled by white fibrous septa were found but milky red globules or irregular linear vessels were not found. Therefore, melanoma almost could be ruled out cautiously. Histopathology showed symmetrical, well-circumscribed, polypoid architecture with predominant dermal nests of spindle cells. Immunohistochemically, the nevus cells were strongly positive for S-100 protein and negative for HMB-45. Thus, the diagnosis of polypoid Spitz nevus was made. Herein, we report a case of polypoid Spitz nevus that was differentiated from polypoid melanoma by histopathologic and dermoscopic findings.

Dermatoscopia do nevo de Spitz pigmentado / Dermatoscopy of the pigmented Spitz nevus

O nevo de Spitz pigmentado consiste em uma lesão melanocítica benigna com características peculiares. Geralmente, melanoma é considerado no diagnóstico diferencial desta lesão, bem como o nevo de Reed. A dermatoscopia representa uma parte relevante da abordagem diagnóstica e, portanto, ela permite um estudo mais eficiente dessas lesões dermatológicas. O presente relato de caso é sobre uma paciente com dois nevos de Spitz pigmentados de localização no tronco e história familial de melanoma, no qual a dermatoscopia associada à histopatologia foram cruciais para o diagnósticos das lesões.

Spitz nevi in the classic histopathological pattern - lamb in wolf`s clothing

Spitz nevus is a benign melanocytic lesion and also one of the main differential diagnosis of melanoma. A descriptive and retrospective study of surgical specimens from patients with a diagnosis of Spitz nevus was conducted at two institutions in Niterói - RJ. 32 cases were analyzed. The most frequent histological subtype was compound (60 %), with a predominance of epithelioid cells (17 cases - 53%). Pagetoid spread was observed in 21 cases (68%). Maturation of melanocytes was present in 13 cases (81%). Kamino bodies were found in eight cases (25%). Atypical melanocytes were present in 18 cases (56%). Mitoses were present in 11 cases (34%). Detailed knowledge of the classical form of Spitz nevi is essential for the differential diagnosis with melanoma. However, no single criterium is definitive in the differential diagnosis between Spitz nevus and melanoma.

Spitz Nevus on the Perianal Area of a Child: An Unusual Location

No abstract available.

A Case of Spitzoid Melanoma

Spitzoid melanoma is a subtype of melanoma that, clinically and histologically, resembles a Spitz nevus. Clinically, spitzoid melanomas usually evolve from amelanotic nodular lesions, growing to 1 cm or more in diameter. They often remain clinically undiagnosed because of their wide variety of clinical appearances and a lack of pigmentation. Distinguishing a Spitz nevus from a spitzoid melanoma can be extremely difficult. Features that favor the diagnosis of a spitzoid melanoma are asymmetrical shape, diameter greater than 1 cm, a lesion with a deep invasive component, and a high degree of cytologic atypia. There have been only rare reports in the literature of the presence of giant cells in malignant melanoma, and the presence of these cells may result in its misdiagnosis as a histiocytic tumor. We present a case of spitzoid melanoma on the right ankle of a 22-year-old-woman.

Nevus de Spitz- variedad de Reed en una niña de 10 años / Spitz Nevus - Reed's variety on a 10 year old girl

Presentamos el caso de una niña de 10 años de edad, con antecedentes personales de nevos atípicos, que consultó en el Servicio de Dermatología de nuestro hospital por una lesión papuloide, hiperpigmentada, localizada en la región anterior de la pierna izquierda compatible con Nevus de Spitz variedad de Reed. Se revisaron las formas de presentación clínica, los métodos diagnósticos (histopatología y dermatoscopía), el diagnósticodiferencial con melanoma y el algoritmo terapéutico...

The Spitz Nevus on the Areola / 대한피부과학회지

No abstract available.