10.5826/dpc.1301a46
text/xml
2160-9381
2516
en
Soumia  Chiheb
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Atypical Verrucous Presentation of Spitz Nevus
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-01-31
2022-04-05
2023-01-31
2023-03-01
e2023046
Dermatol Pract Concept
Soumia  Chiheb
2023/01/31
10.5826/dpc.1301a46
e2023046
Dermatology department, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
2160-9381
en
e2023046
Lallas A, Apalla Z, Ioannides D, et al. Update on dermoscopy of Spitz/Reed naevi and management guidelines by the International Dermoscopy Society. Br J Dermatol. 2017;177(3):645-655. DOI: 10.1111/bjd.15339. PMID: 28118479.
Atypical Verrucous Presentation of Spitz Nevus
https://dpcj.org/index.php/dpc/article/download/2516/1923
      Atypical Verrucous Presentation of Spitz Nevus
                               Awatef Kelati1,2,3,4, Kenza Oqbani5, Soumia Chiheb1


1 Dermatology department, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS),
  Casablanca, Morocco
2 Member of the International Dermoscopy Society Task Force of dark skin’s imaging
3 Non-invasive skin imaging group of the French Society of Dermatology
4 Non-invasive skin imaging group of the Moroccan Society of Dermatology
5 Pathology department, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS),
  Casablanca, Morocco



Citation: Kelati A, Oqbani K, Chiheb S. Atypical Verrucous Presentation Of Spitz Nevus. Dermatol Pract Concept. 2023;13(1):e2023046.
DOI: https://doi.org/10.5826/dpc.1301a46
Accepted: September 6, 2022; Published: January 2023
Copyright: ©2023 Kelati 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: Kelati Awatef, Dermatology Department, Cheikh Khalifa International University Hospital, Mohammed VI
University of Health Sciences (UM6SS), Casablanca, Morocco. E-mail: akelati@um6ss.ma




Case Presentation                                                        Teaching Point
A seven-year-old girl, without any medical history, presented            Spitzoid melanocytic lesions represent a challenging spec-
with a 4-year history of an asymptomatic pigmented lesion on             trum frombenign spitz nevi to malignant spitzoid melanoma,
the left ankle, which started to change and to grow - a­ ccording        because of the morphological and dermoscopic overlap be-
to the family - since one year. Dermatological examination               tween them [1,2]).
revealed a pigmented verrucous nodule of the left ankle                       Spitz nevi arise more commonly in females, and in
(­Figure 1A). No other lesions were found. Contact dermos-               childhood but may occur at any age. There are 3 dermo-
copy revealed an irregular asymmetric peripheral network,                scopic patterns that may be considered as suggestive of
and central white globular structures surrounding violaceus              Spitz nevus: starburst pattern, regularly distributed dotted
vessels in some spots (Figure 1B). Spitzoid melanoma, spitz              vessels and globular pattern with reticular depigmenta-
tumor or collision tumor of spitz nevus and a viral wart were            tion [2]. Although we report through this observation an
discussed. The lesion was excised, histopathology revealed a             atypical multicomponent pattern in a spitz nevus, excision
papillomatous lesion with a predominance of epithelioid me-              should be performed in the case of an asymmetric lesion
lanocytic cells, cellular maturation in the deep dermis, and             with a multicomponent pattern in order to rule out spit-
absence of atypia or mitosis, which confirmed the diagnosis              zoid melanoma.
of verrucous spitz nevus, without any signs of malignancy or
viral cytopathic changes (Figure 1C).




Image Letter | Dermatol Pract Concept. 2023;13(1):e2023046                                                                             1
            Figure 1. Spitz nevus. (A) Pigmented verrucous nodule of the left ankle. (B) Dermoscopy: irregular asymmetric
            peripheral black network (blue arrow) and central white globular structures (red arrows) surrounding violaceus
            vessels in some spots. (C) Histopathology (H&E, x40 magnification): papillomatous lesion with a predominance
            of epithelioid melanocytic cells, cellular maturation in the deep dermis, and absence of atypia or mitosis.




References                                                            2. Lallas A, Apalla Z, Ioannides D, et al. Update on dermoscopy of
                                                                         Spitz/Reed naevi and management guidelines by the International
1. Moscarella E, Al Jalbout S, Piana S, et al. The stars within the      Dermoscopy Society. Br J Dermatol. 2017;177(3):645-655. DOI:
   melanocytic garden: unusual variants of Spitz naevi. Br J Derma-      10.1111/bjd.15339. PMID: 28118479.
   tol. 2015;172(4):1045-1051. DOI: 10.1111/bjd.13347. PMID:
   25123161.




2                                                                           Image Letter | Dermatol Pract Concept. 2023;13(1):e2023046
