10.5826/dpc.1401a25
text/xml
2160-9381
3514
en
Maria Antonietta Pizzichetta
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Synchronous Melanomas Within Nevus Spilus
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2024-01-31
2023-05-07
2024-01-31
2024-02-21
e2024025
Dermatol Pract Concept
Maria Antonietta Pizzichetta
2024/01/31
10.5826/dpc.1401a25
e2024025
Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, Trieste, Italy
2160-9381
en
e2024025
Simonetta Piana MD MCGMGMRMGM. Multifocal melanoma arising on nevus spilus.
Synchronous Melanomas Within Nevus Spilus
https://dpcj.org/index.php/dpc/article/download/3514/2555
         Synchronous Melanomas Within Nevus Spilus
   Federico Sansoni1, Ludovica Toffoli1, Alberto Zacchi3, Marina Agozzino1, Iris Zalaudek1,
                       Nicola Di Meo1, Maria Antonietta Pizzichetta1,2


1 Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, Trieste, Italy
2 Division of Medical Oncology - Preventive Oncology, National Cancer Institute, Aviano, Italy
3 Patology Department of Trieste, Cattinara Hospital, University of Trieste, Italy



Citation: Sansoni F, Toffoli L, Zacchi A, et al. Synchronous Melanomas Within Nevus Spilus. Dermatol Pract Concept.
2024;14(1):e2024025. DOI: https://doi.org/10.5826/dpc.1401a25
Accepted: May 22, 2023; Published: January 2024
Copyright: ©2024 Sansoni et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial 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: Federico Sansoni MD, Dermatology Clinic of Trieste, Maggiore Hospital, University of Trieste, Trieste, Italy.
Phone: +39 0403992056 Email: federicosansoni95@gmail.com




Dear Editor,                                                             skin examination, there was no personal or family history of
                                                                         skin cancers. On the right upper quadrant of the abdomen, we
    Nevus spilus (NS), also known as speckled lentiginous                noticed a 5.5x1.8 cm speckled lentiginous nevus with a small
nevus, is a hyperpigmented macule or patch with superim-                 hyperpigmented slightly palpable lesion measured 6x5mm.
posed darker speckles that usually appears in infancy or                 Dermoscopy showed within the lentiginous background a
childhood.                                                               reddish area and an irregular pigmented network with some
    It corresponds to a focal proliferation of melanocytes               peripheral streaks (suggestive of melanoma) and comedo-like
along the basal layer of the epidermis within a lentiginous              openings in the center (suggestive of seborrheic keratosis).
background. The speckles display the histological features                    Histological analysis of the biopsied sample revealed a
of different type of nevi such as junctional, intradermal, dys-          superficially spreading melanoma with a Breslow thickness
plastic, Spitz and blue nevus. NS can be divided into 3 cat-             of 0.3mm (pT1a) with lichenoid regression and acanthosis.
egories regarding its dimension: small if >1.5 cm, medium                A further surgical excision was carried out with the complete
from 1.5 to 19.9 cm and large if >20 cm [1,2].                           removal of the NS. In the new skin sample an in-situ mela-
    The possible occurrence of melanoma within the nevus                 noma outbreak was also found. Dermatological follow-up is
has been described in literature in about 40 cases to date,              now performed every 6 months.
usually in patients aged around 50 years [3,4]. The presence                  NS can be seen as a “melanocytic garden” in which dif-
of NS since birth, the dimension over 4 cm in diameter, the              ferent lesions can grow based on the melanocyte differentia-
giant or zosteriform type are associated with higher risk to             tion pathway. Up to date, NS is usually not considered as a
develop melanoma [4]. The frequency of this transformation               precursor of melanoma nevertheless, his malignant potential
is significant, but it appears to be lower than congenital nevi          is described in literature. In the reported few cases of mel-
of the same size[4].                                                     anoma the most common types of melanoma were super-
    Herein we report the case of a 72-year-old male with 2 mel-          ficially spreading melanoma (68%) and nodular melanoma
anomas within a NS. He came to our department for his first



Letter to the Editor | Dermatol Pract Concept. 2024;14(1):e2024025                                                                      1
     Table 1. The features of the cases of synchronous melanomas within a nevus spilus in literature.
 Sex     Age NS present since         Dimensions of NS                Location                   Breslow (mm)                   Note
     6
 M       28    unknow                 5 cm                    left arm                    0.7 mm; 0.7 mm; 0.3 mm           no ulceration
     4
 M       32    infancy                10 cm                   Intergluteal groove         3.5 mm; 1.25 mm                  CDKN2A+
     5
 M       60    childhood              15x10 cm                Medial left calf            0.8 mm; 0.8 mm                   no ulceration
 M3      83    birth                  27 cmx10 cm             right arm and forearm 2.51 mm; 1.18 mm; in situ no ulceration




 Figure 1. (A) Nevus spilus of the right upper quadrant of the abdomen. Dermoscopy revealed macules and papules within a patch of tan-
 to-brown hyperpigmentation. In particularly, an hyperpigmented papule on the left inferior part of the nevus was noticed. (B) ­Dermoscopy
 revealed irregular pigmented network with a reddish area and some peripheral streaks. Moreover, SK features such as comedo-like
 ­openings and milia-like cysts were observed.



(16%), in rare cases also melanoma in situ. Our case con-                2. Corradin MT, Zattra E, Fiorentino R, Alaibac M,
firms the presence of the most frequent histotype, but also                 Belloni-Fortina A. Nevus spilus and melanoma: Case report and
                                                                            review of the literature. J Cutan Med Surg. 2010;14(2):85-89.
highlights the occurrence of synchronous melanoma in situ.
                                                                            DOI:10.2310/7750.2009.08090. PMID: 20338124.
Only 4 cases of synchronous melanomas within a NS are
                                                                         3. Brito MH, Dionísio CS, Fernandes CM, Ferreira JC, Rosa MJ,
reported [3-6] (Table 1).                                                   Garcia MM. Synchronous melanomas arising within n       ­evus
     Dermoscopically, in our case the presence of melanoma                  spilus. An Bras Dermatol. 2017;92(1):107-109. DOI: 10.1590
was also partially hidden by seborrheic keratosis features,                 /abd1806-4841.20175230.       PMID:      28225967.     PMCID:
however considering the possibility of melanoma within a                    PMC5312189.
                                                                         4. Abecassis S, Spatz A, Cazeneuve C, et al. Mélanome sur naevus
NS a biopsy was necessary to solve the diagnostic problem.
                                                                            spilus: 5 observations [Melanoma within naevus spilus: 5 cases].
     Changing pigmented areas or nodules require selective
                                                                            Ann Dermatol Venereol. 2006;133(4):323-328. DOI: 10.1016
biopsy for histological examination. In the case of a positive              /s0151-9638(06)70909-7. PMID: 16733445.
histological test, a complete excision of the entire NS is re-           5. Meguerditchian AN, Cheney RT, Kane JM. Nevus spilus
quired, in order to search for any multifocal melanomas such                with synchronous melanomas: case report and literature re-
as in our case.                                                             view. J Cutan Med Surg. 2009;13(2):96-101. DOI:10.2310/7750
                                                                            .2008.07090. PMID: 19298778.
                                                                         6. Piana S, Gelli MC, Grenzi L, Ricci C, Gardini S, Piana S.
References                                                                  ­Multifocal melanoma arising on nevus spilus. Int J Dermatol.
                                                                             2006;45(11):1380-1381. DOI: 10.1111/j.1365-4632.2006.
 1. Corradin MT, Cacitti V, Giulioni E, Patriarca MM, Vettorello
                                                                             03110.x. PMID: 17076737.
    A. Nevus Spilus: A Review of the Literature. SM Dermatology
    Journal. 2015;1(1):1-7.




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