Subject(s)
Cell Transformation, Neoplastic/pathology , Melanoma/pathology , Nevus, Blue/pathology , Nevus, Epithelioid and Spindle Cell/pathology , Skin Neoplasms/pathology , Biopsy, Needle , Cohort Studies , Diagnosis, Differential , Female , Humans , Immunohistochemistry , Male , Melanoma/physiopathology , Nevus, Blue/physiopathology , Nevus, Epithelioid and Spindle Cell/physiopathology , Risk Assessment , Skin Neoplasms/physiopathologyABSTRACT
The eruptive disseminated form of Spitz nevi (EDSN) is the rarest variant, is cosmetically disabling, and has a poorly documented natural history. We report the case of a 4-year-old boy with more than 100 Spitz nevi that have significantly regressed 8 years after onset. There is no satisfactory treatment for EDSN. There have been no reports of supervening malignancy. Our case illustrates the possibility of regression of EDSN, corroborating long-term observation as a safe and acceptable management option.
Subject(s)
Nevus, Epithelioid and Spindle Cell/physiopathology , Skin Neoplasms/physiopathology , Child, Preschool , Humans , Male , Nevus, Epithelioid and Spindle Cell/diagnosis , Observation/methods , Remission, Spontaneous , Skin Neoplasms/diagnosis , Watchful Waiting/methodsABSTRACT
Digital dermoscopy follow-up helps to identify patterns of change typical of common atypical nevi and early melanoma and improves the follow-up of patients with atypical nevi. We report the morphologic changes observed over time in 19 atypical or equivocal acquired melanocytic nevi that underwent dermoscopic follow-up. Two observers retrospectively examined digitalized dermoscopic images of 19 atypical melanocytic nevi from 15 children and young adults (median age 12 years, range 3-26 years). The images were assessed for global dermoscopic patterns at baseline and after a median 25-month (range 6-138 mos) follow-up. Ten (52.6%) nevi changed and nine (47.4%) retained a stable dermoscopic pattern. Of the 10 changing lesions, 2 of 4 homogeneous nevi evolved into a reticular pattern and 2 into a mixed pattern; 1 of 2 nevi with a mixed pattern evolved into a homogeneous nevus and 1 into a regressing nevus; 1 of 2 nevi with "other" patterns, such as negative pigment network and peppering throughout the lesion, evolved into a mixed nevus and 1 into a regressing nevus; 1 globular nevus evolved into a mixed pattern; and 1 starburst nevus evolved into a homogeneous nevus. The most striking results of our study were that atypical nevi can evolve into common nevi or they can regress, as documented by long-term dermoscopic follow-up. In children and young adults, dermoscopic follow-up of atypical nevi might be a valid alternative to surgical excision and enables us to achieve new insights into the natural history of these nevi.
Subject(s)
Nevus, Epithelioid and Spindle Cell/pathology , Nevus, Pigmented/pathology , Skin Neoplasms/pathology , Adolescent , Adult , Child , Child, Preschool , Disease Progression , Female , Follow-Up Studies , Humans , Male , Nevus, Epithelioid and Spindle Cell/physiopathology , Nevus, Pigmented/physiopathology , Skin Neoplasms/physiopathology , Watchful Waiting , Young AdultABSTRACT
BACKGROUND: Deregulated cell cycle control is one of the hallmarks of tumor development. The expression of different cell cycle regulators has been used in various neoplasms as an adjunct to diagnosis. OBJECTIVE: We sough to determine the expression of cell cycle and apoptosis regulators in Spitz nevi and to appraise its value as a diagnostic adjunct in the differential diagnosis from melanomas and common nevi. METHODS: Ki-67, p-27, p-16, p-53, p-21, Rb, cyclin D1, cyclin A, cyclin B1, bcl-2, and bax expression was assessed by immunohistochemistry in 10 Spitz nevi and was compared with 16 melanomas and 20 common nevi immunohistochemical expression. RESULTS: P-27 (60% +/- 20.13), p-16 (62.00% +/- 10.85), and bcl-2 (46.00% +/- 42.47) were highly expressed in Spitz nevi, whereas Ki-67 (2.80% +/- 2.55), Rb (3.75% +/- 4.55), p-53 (2.30% +/- 0.10), cyclin A (0.70% +/- 1.56), B1 (0.20% +/- 0.34), and bax (2.65% +/- 6.37) demonstrated a limited expression. Cyclin D1 (8.60% +/- 7.30) and p-21 (6.40% +/- 5.37) showed a moderate expression. The expression of bax (P = .001), Ki-67 (P < .0001), Rb (P < .0001), p-16 (P < .0001), cyclin A (P < .0001), and cyclin B1 (P < .0001) was significantly higher in melanomas in comparison with Spitz nevi, whereas p-27 expression was significantly higher in Spitz nevi (P < .0001). A trend for significant difference in favor of melanomas was also observed for p-53 (P = .002). On the other hand, no difference was detected for bcl-2 (P = .275), p-21 (P = .055), or cyclin D1 (P = .077). Spitz nevi demonstrated a trend for a higher expression for p-21 (P = .008) and cyclin D1 (P = .006), whereas they exhibited lower p-16 (P = .004) in comparison with common nevi. LIMITATIONS: The number of Spitz nevi was relatively small. CONCLUSION: Spitz nevi differ from melanomas in their immunohistochemical pattern of expression of cell cycle and apoptosis regulators and more closely resemble common benign nevi.
