10.5826/dpc.1203a103
text/xml
2160-9381
1949
en
Francisco Macedo Paschoal
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Skin Cancer
Cutaneous spitzoid melanoma in childhood after acute lymphocytic leukemia
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-07-28
2021-08-09
2022-07-28
2022-09-15
e2022103
Dermatol Pract Concept
Francisco Macedo Paschoal
2022/07/28
10.5826/dpc.1203a103
e2022103
Discipline of Dermatology, Centro Universitário FMABC, Santo André, Brazil.
2160-9381
Skin Cancer
en
e2022103
KL, Lowe L, Fullen DR, Harms PW. Atypical Spitz Tumors: A Diagnostic Challenge. Arch Pathol Lab Med. 2015;139(10):1263-1270. DOI: 10.5858/arpa.2015-0207-RA. PMID: 26414472.
Cutaneous spitzoid melanoma in childhood after acute lymphocytic leukemia
https://dpcj.org/index.php/dpc/article/download/1949/1654
                    Dermatology Practical & Conceptual


           Cutaneous Spitzoid Melanoma in Childhood
               After Acute Lymphocytic Leukemia
           Beatriz Ferreira do Prado Bassetti1, Sergio Albertini Daiuto1, Gilles Landman2,
                                    Francisco Macedo Paschoal3


1 Medical Student, Centro Universitário FMABC, Santo André, Brazil.
2 Department of Pathology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
3 Discipline of Dermatology, Centro Universitário FMABC, Santo André, Brazil.



Keywords: melanoma, Acute Lymphocytic Leukemia, Spitz Nevus, Skin Cancer
Citation: Bassetti BFP, Daiuto SA, Landman G, Paschoal FM. Cutaneous spitzoid melanoma in childhood after acute lymphocytic leukemia.
Dermatol Pract Concept. 2022;12(3):e2022103. DOI: https://doi.org/10.5826/dpc.1203a103
Accepted: November 4, 2021; Published: July 2022
Copyright: ©2022 Ferreira do Prado Bassetti et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/ which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Sergio Albertini Daiuto, Discipline of Dermatology at Centro Universitário FMABC, Avenida Lauro Gomes, 2000 -
Vila Sacadura Cabral, CEP: 09060-870, Santo André - São Paulo, Brazil E-mail: s.daiuto@gmail.com




Introduction                                                                  The initial hypotheses were keratinocytic or vascular
                                                                         neoplasms being performed incisional biopsy for diagnosis.
Acute lymphocytic leukemia (ALL) is the most common                      A histopathological analysis showed a neoplasm with cells
childhood malignancy. It has a good prognosis but one-third              arranged in nests, ample and eosinophilic cytoplasm, with
of all childhood ALL deaths are due to toxicity or secondary             oval or rounded nuclei and prominent nucleoli, whose diag-
malignancies. We report the case of a patient with a personal            nosis was infiltration by primary melanoma. Excisional bi-
history of ALL who had cutaneous spitzoid melanoma at the                opsy confirmed the diagnosis of nodular, ulcerated, spitzoid,
beginning of puberty.                                                    Clark V melanoma with tumor thickness (Breslow) of 4.7
                                                                         mm (Figures 2). Surgical treatment with wide excision was
                                                                         performed, followed by adjuvant treatment with interferon
Case presentation
                                                                         alpha 2b at a dose of 6350,000 IU, subcutaneously, 3 times
A 13-year-old female patient from São Paulo, Brazil, pre-                a week for 2 years, the only adjuvant treatment available at
sented, in 2015, a well-defined, erythematous, ulcerated                 the time of diagnosis. The patient remained in oncological
brown nodule in the left temporal region, with a 1-year evo-             follow-up for 5 years and in remission of both neoplasms.
lution (Figure 1A). She presents a personal history of ALL
diagnosed in 2013, treated with chemotherapy. Dermoscopy
                                                                         Conclusions
shows polymorphic vessels, exulceration, hematic crusts, and
chrysalis (Figure 1B). No specific finding of the melanocytic            This case report shows a remarkable clinical similarity with
lesion was present.                                                      what was reported by Goldes et al. in 1984, whose initial




Research Letter | Dermatol Pract Concept. 2022;12(3):e2022103                                                                           1
                Figure 1. (A) Well-delimited, ulcerated brown nodule on the left temporal skin. (B) Dermoscopy showing
                polymorphic vessels, exulceration, hematic crusts and chrysalis streaks.



                                                                         Nevertheless, in certain situations only the development of
                                                                         metastasis will define the diagnosis. We can assume that the
                                                                         approach presented in the face of the diagnosis of spitzoid
                                                                         melanoma (wide excision and adjuvant immunotherapy)
                                                                         may have influenced the outcome of the present report. The
                                                                         most common secondary malignant neoplasms after ALL
                                                                         are lymphoreticular (acute myelocytic leukemia and Hod-
                                                                         gkin disease), followed by endocrine, keratinocytic, and
                                                                         renal tumors. Immunosuppression by chemotherapy and
                                                                         radiotherapy is related to an increased risk of developing
Figure 2. Melanocytic neoplasm characterized by proliferation of cells   a subsequent neoplasm but not necessarily related to their
that are either epithelioid or fusiform with eosinophilic cytoplasm,     causes. In addition to being rare in childhood, the occurrence
whose nuclei have a moderate degree of polymorphism and promi-           of cutaneous melanoma as a secondary neoplasm after ALL,
nent nucleoli, forming an extensive dermal lesion (H&Eeosin, 100x).      is even more uncommon, and this case in our knowledge is
                                                                         the second case reported in the literature. However, it should
diagnosis, however, was Spitz nevus, but the patient died                be considered mainly in the presence of a pigmented nodule
of metastatic melanoma [1]. The differential diagnosis be-               on the face.
tween spitz nevus in its atypical presentation, such as ag-
gressive spitz tumor of undetermined biological significance,
and spitzoid melanoma is a major challenge [2]. Both may
                                                                         References
share findings such as fusiform melanocytes, prominent nu-                1. Goldes J, Holmes S, Satz M, Cich J, Dehner L. Melanoma
cleoli, junctional nests, diameter greater than 10 mm, and                   masquerading as Spitz nevus following acute lymphoblastic
high-grade nuclear atypia. The characteristics that favor the                leukemia. Pediatr Dermatol. 1984;1(4):295-298. DOI: 10.1111/
                                                                             j.1525-1470.1984.tb01132.x. PMID: 6593699.2. Harms
diagnosis of melanoma are greater depth of the lesion, in-
                                                                             KL, Lowe L, Fullen DR, Harms PW. Atypical Spitz Tumors: A
volvement of reticular and subcutaneous dermis, mitosis in                   Diagnostic Challenge. Arch Pathol Lab Med. 2015;139(10):1263-
the deep dermis, nuclear and cellular pleomorphism, asym-                    1270. DOI: 10.5858/arpa.2015-0207-RA. PMID: 26414472.
metry and ill-defined limits, all of them present in our report.




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