10.5826/dpc.1204a172
text/xml
2160-9381
2167
en
Elvira Moscarella
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Atypical Spitz nevus: dermoscopic, confocal microscopic and histopathological correlation
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2022-10-31
2021-11-14
2022-10-31
2022-12-01
e2022172
Dermatol Pract Concept
Elvira Moscarella
2022/10/31
10.5826/dpc.1204a172
e2022172
Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
2160-9381
en
e2022172
Atypical Spitz nevus: dermoscopic, confocal microscopic and histopathological correlation
https://dpcj.org/index.php/dpc/article/download/2167/1804
        Atypical Spitz Nevus: Dermoscopic, Confocal
       Microscopic and Histopathological Correlation
     Rita Bouceiro Mendes1, Camila Scharf2, Eugenia Veronica Di Brizzi2, Andrea Ronchi3,
                         Giuseppe Argenziano2, Elvira Moscarella2


1 Dermatology Unit, North Lisbon University Hospital Centre, Lisbon, Portugal.
2 Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy.
3 Pathology Unit, University of Campania L. Vanvitelli, Naples, Italy.



Citation: Bouceiro Mendes R, Scharf C, Di Brizzi EV, Ronchi A, Argenziano G, Moscarella E. Atypical Spitz nevus: dermoscopic,
confocal microscopic and histopathological correlation. Dermatol Pract Concept. 2022;12(4):e2022172. DOI: https://doi.org/10.5826/
dpc.1204a172
Accepted: January 14, 2022; Published: October 2022
Copyright: ©2022 Bouceiro Mendes 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: Rita Bouceiro Mendes, North Lisbon University Hospital Centre, Dermatology Department, Piso 5, Av. Prof. Egas
Moniz, 1649-035 Lisboa. Phone: 00351 969928106, E-mail: rita.bouceiro.mendes@gmail.com




Case presentation                                                        Teaching point
A 12-year-old girl was observed for a new asymmetric pink and            Atypical Spitz nevi represent an intermediate category of
black papule on her back. Dermoscopy revealed a multicom-                melanocytic lesions whose differentiation from melanoma is
ponent pattern with pink pigmentation, and blue-white veil.              difficult because of overlapping features [1]. RCM represents
By reflectance confocal microscopy (RCM) overall asymmetry               a noninvasive diagnostic add-on, but RCM features of atypi-
was noted. Irregular honeycomb pattern of the epidermis and              cal Spitz tumors are not well characterized [1,2].
compact dermal nests, matching the pink pigmentation area                     Confocal features that may help to differentiate Spitz
were evident while, in the blue-white veil dermoscopic area,             nevi from melanoma have already been identified [2]; how-
multiple superficial dendritic cells and an irregular meshwork           ever, a study from Guida et al stated that RCM was not
pattern at the dermal-epidermal junction were seen. Consid-              useful in lesions with multicomponent or unspecific dermo-
ering these findings, surgical excision was performed. Histo-            scopic patterns since many “malignant” features were shared
pathological examination disclosed an asymmetric compound                between both entities [1]. We are able to overcome this gap
proliferation of melanocytic epithelioid cells. Its junctional           if we consider the patient age when evaluating a spitzoid le-
element was predominantly nested, whereas the dermal as-                 sion. Besides that, this case illustrates the RCM features of
pect was highly cellular with fascicles of slightly pleomorphic          an atypical Spitz nevus with an impressive dermoscopic and
epithelioid cells throughout the entire dermis. These findings           histopathological correlation.
favored the diagnosis of atypical Spitz nevus.




Image Letter | Dermatol Pract Concept. 2022;12(4):e2022172                                                                            1
Figure 1. Spitz nevus. (A) Clinical picture: asymmetric 1cm diameter papule with uneven pink and black color. (B) Dermoscopy picture:
multicomponent pattern with irregular brown and pink pigmentation, and blue-white veil. (C) Confocal microscopy picture: C1 - epidermal
honeycombed structures and thin dermal papillae; C2 - irregular meshwork pattern at the dermal-epidermal junction and associated areas of
totally disarranged papillary contours owing to multiple bright fusiform cells with dendrites (white asterisks). (D) Histopathological pictures:
D1 - Overall asymmetric polypoid-like melanocytic compound proliferation with an important deep component. The junctional element of
the lesion is predominantly nested while the dermal aspect is highly cellular (white asterisk) (H&E, x25). D2 - Higher magnification showing
the cellular dermal component of slightly pleomorphic epithelioid cells organized in fasciles. These cells immunostaining for HMB-45 was
positive throughout the entire dermis (H&E, x100).




References                                                                 2. Pellacani G, Longo C, Ferrara G, et al. Spitz nevi: In vivo confo-
                                                                              cal microscopic features, dermatoscopic aspects, histopathologic
 1. Guida S, Pellacani G, Cesinaro AM, et al. Spitz naevi and mela-           correlates, and diagnostic significance. J Am Acad Dermatol.
    nomas with similar dermoscopic patterns: can confocal micros-             2009;60(2):236-247. DOI: 10.1016/j.jaad.2008.07.061. PMID:
    copy differentiate? The Br J Dermatol. 2016;174(3):610-616.               19091443.
    DOI: 10.1111/bjd.14286. PMID: 26554394.




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