10.5826/dpc.1202a50
text/xml
2160-9381
1736
en
Giuseppe Argenziano
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
melanoma
Spitz Nevus of the Vulva: A Very Rare Presentation in the Genital Region
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-05-02
2021-03-29
2022-05-02
2022-05-24
e2022050
Dermatol Pract Concept
Giuseppe Argenziano
2022/05/02
10.5826/dpc.1202a50
e2022050
Unit of Dermatology, Luigi Vanvitelli University of Campania, Naples, Italy  
2160-9381
melanoma
en
e2022050
Murzaku EC, Penn LA, Hale CS, Pomeranz MK, Polsky D. Vulvar nevi, melanosis, and melanoma: an epidemiologic, clinical, and histopathologic review. J Am Acad Dermatol. 2014;71(6):1241-1249. DOI: 10.1016/j.jaad.2014.08.019. PMID: 25267379.
Spitz Nevus of the Vulva: A Very Rare Presentation in the Genital Region
https://dpcj.org/index.php/dpc/article/download/1736/1559
                    Dermatology Practical & Conceptual


    Spitz Nevus of the Vulva: a Very Rare Presentation
                  of the Genital Region
             Mario Vaccaro1, Marialorena Coppola1, Maria Lentini2, Francesco Borgia1,
                             Elvira Moscarella3, Giuseppe Argenziano3


1
  Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
2
  Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
3
  Unit of Dermatology, Luigi Vanvitelli University of Campania, Naples, Italy



Key words: Spitz nevus, vulva, dermoscopy, melanoma
Citation: Vaccaro M, Coppola M, Lentini M, Borgia F, Moscarella E, Argenziano G. Spitz nevus of the vulva: a very rare presentation of
the genital region. Dermatol Pract Concept. 2022;12(2):e2022050. DOI: https://doi.org/10.5826/dpc.1202a50
Accepted: August 8, 2021; Published: April 2022
Copyright: ©2022 Vaccaro 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: Mario Vaccaro, Department of Clinical and Experimental Medicine, - Dermatology- University of Messina,
Messina, Italy. Via C. Valeria, Gazzi. 98125 Messina, Italy. E-mail:vaccaro@unime.it




Introduction                                                            with grayish shades and large brown-black globules, widely
                                                                        spaced and arranged asymmetrically (Figure 1B). An excision
Spitz nevi of special sites, such as the vulva-, appear rare and        biopsy was made, and histological examination revealed a
can pose a challenge as they may display worrisome clini-               compound Spitz nevus, characterized by a proliferation of pig-
cal-dermoscopic or histopathological features [1-4]. Here we            mented and epithelioid melanocytes, with no mitoses or atyp-
clinically, dermoscopically and histopathologically describe            ical features, arranged in dermal nests and partially aligned
an extremely rare case of Spitz nevus occurring on the vulva            at the dermo-epidermal junction. Melanocytes showed vesicu-
of a 47-year-old woman.                                                 lar nuclei, small nucleoli and a homogeneous cytoplasm with
                                                                        many melanin granules. Mild perilesional lymphocytic infil-
                                                                        tration was observed (Figure 2, A_C). Given the peculiar area,
Case Presentation
                                                                        recent onset, rapid growth and dermoscopic features, the le-
A healthy 47-year-old Italian woman presented with a 2-month            sion was completely removed with clear surgical margins, and
history of a rapidly growing lesion on the outer surface of the         no recurrence was observed in the 6 months after the excision.
left labium majus of the genitalia, without pain, pruritus or
hemorrhage. Physical examination showed an asymmetric,
                                                                        Discussion
dark-brown papule, 9 mm in diameter, well circumscribed
(Figure 1A). No inguinal lymphadenopathy was revealed.                  Melanocytic lesions of the female genital area are estimated
Dermoscopy showed an asymmetric melanocytic lesion with a               to occur in 10% to 12% of women and arise mainly in the
basically cobblestone pattern, a diffuse blackish pigmentation          vulva. These lesions, commonly detected during routine




Research Letter | Dermatol Pract Concept. 2022;12(2):e2022050                                                                            1
Figure 1. Spitz nevus of the vulva. (A) Clinicalfeatures. (B) Dermoscopicfeatures.




Figure 2. (A) Pigmented melanocytic proliferation expanding superficial dermis with mild epidermal hyperplasia (H%E, scanning magnifica-
tion x10). (B) Proliferation of pigmented and epithelioid melanocytes arranged in dermal nests and partially aligned at the dermo-epidermal
junction (H&E, scanning magnification x20). (C) Melanocytes with vesicular nuclei, small nucleoli and a homogeneous cytoplasm with many
melanin granules (H&E, scanning magnification x40).




dermatologic or gynecologic examination, include mela-                  Conclusions
nocytic nevi, melanosis, Spitz nevi, atypical melanocytic
nevi of the genital type, dysplastic nevi and melanomas [4].            In presence of new onset pigmented papules or nodules in
Spitz nevi of the vulva are very rare, with only a few cases            the genital area of women, melanoma should be included in
described in the literature. . Polat et al. described a case of         the differential diagnosis and especially in those older than
an 11-year-old girl with a Spitz nevus on the inner surface             50 years, histological examination should be performed to
of the labium majus of the genitalia [5]. In another ret-               rule out melanoma. In this report, given the peculiar area, re-
rospective study about the clinical and dermoscopic char-               cent onset, rapid growth and dermoscopic features, surgical
acteristics of genital melanocytic nevi in children, 2more              excision was warranted. Our case highlights the importance
cases of Spitz nevi on the labia majora have been reported              of assessing the genital region during routine skin cancer
[6]. In adult patients spitzoid lesions may pose diagnos-               screening examination, with particular attention about any
tic difficulties as melanoma may mimic Spitz nevi from a                new or changing lesions.
morphological point of view. Melanoma is the second most
common malignancy of the vulva after squamous cell car-
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2                                                                            Research Letter | Dermatol Pract Concept. 2022;12(2):e2022050
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    PMID: 21311169                                                         PMID: 25267379.




Research Letter | Dermatol Pract Concept. 2022;12(2):e2022050                                                                         3
