10.5826/dpc.1204a153
Angiomatoid Spitz nevus is an uncommon histopathological variant of Spitz nevus that is most frequently seen on the extremities of children and young adults. Dermatoscopic features of this unusual variant have rarely been reported. We presented a 19-year-old female diagnosed with angiomatoid Spitz nevus based on the clinical, dermatoscopic, and histopathological findings.
Polarized-light dermatoscopic examination showed a red structureless background, white lines reticular, numerous coiled vessels without specific arrangement and surface scale.
Although the dermatoscopic findings we described in this case can be observed in SN in general, we believe that the predominancy of coiled vessels may be an important clue to the angiomatoid variant of SN.
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2160-9381
1872
en
Asuman Kilitçi
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
angiomatoid Spitz nevus, coiled vessels, dermoscopy
Dermatoscopic features of angiomatoid spitz nevus: a case report
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-10-31
2021-07-07
2022-10-31
2022-11-29
e2022153
Dermatol Pract Concept
Angiomatoid Spitz nevus is an uncommon histopathological variant of Spitz nevus that is most frequently seen on the extremities of children and young adults. Dermatoscopic features of this unusual variant have rarely been reported. We presented a 19-year-old female diagnosed with angiomatoid Spitz nevus based on the clinical, dermatoscopic, and histopathological findings.
Polarized-light dermatoscopic examination showed a red structureless background, white lines reticular, numerous coiled vessels without specific arrangement and surface scale.
Although the dermatoscopic findings we described in this case can be observed in SN in general, we believe that the predominancy of coiled vessels may be an important clue to the angiomatoid variant of SN.
Asuman Kilitçi
2022/10/31
10.5826/dpc.1204a153
e2022153
Department of Pathology, Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey
2160-9381
angiomatoid Spitz nevus, coiled vessels, dermoscopy
en
e2022153
Dermatoscopic features of angiomatoid spitz nevus: a case report
https://dpcj.org/index.php/dpc/article/download/1872/1776
        Dermatoscopic Features of Angiomatoid Spitz
                  Nevus: a Case Report
                                Belkız Uyar1, Ömer Faruk Elmas2, Asuman Kilitçi3


1 Department of Dermatology, Faculty of Medicine, Düzce University, Düzce, Turkey
2 Department of Dermatology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
3 Department of Pathology, Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey



Key words: angiomatoid Spitz nevus, coiled vessels, dermoscopy, immunohistochemistry
Citation: Uyar B, Elmas ÖF, Kilitçi A. Dermatoscopic features of angiomatoid spitz nevus: a case report. Dermatol Pract Concept.
2022;12(4):e2022153. DOI: https://doi.org/10.5826/dpc.1204a153
Accepted: January 14, 2022; Published: October 2022
Copyright: ©2022 Uyar 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: Belkız Uyar, Assoc. Prof. Department of Dermatology, Faculty of Medicine, Düzce University, Düzce, Turkey,
Merkez, Yörükler Mah Konuralp yerleşkesi, 81620 Düzce Merkez/Düzce, Telephone: 90 380 543 13 90-6324;
E-mail address: belkisuyar@gmail.com




Introduction                                                             lines reticular, numerous coiled vessels without specific
                                                                         ­arrangement, and surface scale (Figure 1B). The lesion was to-
Angiomatoid Spitz nevus (SN) is an uncommon histopatho-                  tally excised with the preliminary diagnoses of hemangioma,
logical variant of SN that is most frequently seen on the                SN, dermatofibroma, amelanotic melanoma, and eccrine po-
extremities of children and young adults. Dermatoscopic                  roma. Histopathological examination showed a symmetrical
features of this unusual variant have rarely been reported               lesion composed of predominantly spindle and less often
[1,2]. We presented a 19-year-old female diagnosed with                  epithelioid cells containing eosinophilic cytoplasm. The cells
angiomatoid SN based on the clinical, dermatoscopic, and                 were distributed mostly in vertically oriented nests along the
histopathological findings.                                              dermo-epidermal junction. Maturation to the depth was evi-
                                                                         dent. There were numerous superficial small and thin-walled
                                                                         blood vessels within the fibrotic collagen bundles. A dense,
Case Presentation
                                                                         diffuse lymphocyte-predominant inflammatory infiltrate was
An otherwise healthy 19-year-old female presented with an                also observed (Figure 1, C and D; Figure 2A). No signifi-
asymptomatic, slowly growing, nodule for 4 months. Phys-                 cant atypia and mitotic activity were detected. Immunohis-
ical examination demonstrated an exophytic, non-tender,                  tochemical staining HMB-45 ­(Figure 2B) and Melan-A were
erythematous nodule 0.8 x 0.6 cm in diameter on the right                focally positive within the superficial dermal nests, while p16
pretibial region (Figure 1A). Medical history and systematic             (Figure 2C) and S100 showed diffuse positivity. A diagnosis
review were unremarkable. Polarized-light dermatoscopic                  of angiomatoid SN was made based on the clinical, dermato-
examination showed a red structureless background, white                 scopic, histopathological and immunohistochemical features.



Research Letter | Dermatol Pract Concept. 2022;12(4):e2022153                                                                         1
    Figure 1. (A) A hemangioma-like dome-shaped nodular lesion on the right
    pretibial region. (B) Dermatoscopy revealed red structureless background,
    white lines reticular, coiled vessels without specific arrangement and surface
    scale. (C;D) Histopathological sections showed hyperkeratosis, hypergranulo-
    sis, vertically-oriented nests mainly composed of spindle cells and numerous
    small and thin walled blood vessels within the superficial dermis (H&E, x50).




    Figure 2. (A) The tumor cells show maturation with depth and break up into
    single melanocytes at the base of the lesion (H&E, x50). (B) HMB45 anti-
    body showed staining confined to junctional and superficial dermal component
    (x50). (C) The lesion showed diffuse and strongly positive staining for p16
    (x50).



2                                                Research Letter | Dermatol Pract Concept. 2022;12(4):e2022153
   The consent form was taken from the patient.                 lines reticular and coiled vessels that were not observed in
                                                                the aforementioned studies [1]. Red structureless areas and
                                                                coiled vessels observed in the present case reflect the pro-
Conclusions
                                                                liferation of superficial dermal vessels and inflammation
SN may present with a wide spectrum of clinical and his-        while white lines reticular correspond with fibrotic collagen
topathological appearance. Desmoplastic, angiomatoid,           bundles.
verrucous/polypoid, plexiform, pagetoid, halo, myxoid,             Although the dermatoscopic findings we described in this
granulomatous, and tubular variants have been described         case can be observed in SN in general, we believe that the
in the relevant literature [1]. Angiomatoid SN is character-    predominancy of coiled vessels may be an important clue to
ized by marked proliferation of blood vessels around the in-    the angiomatoid variant of SN.
tradermal melanocytes of SN and clinically manifests as a
hemangioma-like nodular lesion.
   Moscarella et a. reported a total of 307 cutaneous lesions
                                                                References
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out of them were angiomatoid Spitz nevus which are derma-          melanocytic garden: unusual variants of Spitz naevi. Br J Derma-
toscopically showed different combinations of central pink         tol. 2015;172(4):1045-1051. DOI: 10.1111/bjd.13347. PMID:
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to white areas, milky red color, peripheral network, brown
                                                                2. Anju K, Nakamura Y, Okiyama N, et al. Angiomatoid Spitz nevus
to grey streaks, dotted vessels, and linear vessels [1]. Anju
                                                                   with surrounding pagetoid melanocytic proliferation on the sole
et al also reported a case of angiomatoid SN dermatoscopi-         of the foot: An unusual case report with immunohistochemical
cally characterized by reddish homogeneous area with scales        studies for angiogenic factors. J Dermatol. 2020;47(5):538-541.
and dotted linear pigmentation [2]. Our case exhibited white       DOI:10.1111/1346-8138.15275. PMID: 32096247.




Research Letter | Dermatol Pract Concept. 2022;12(4):e2022153                                                                    3
