Clinical and Histopathology Features of Spitz Nevus: In 22 Cases

Authors

1 Associated Professor, Tehran University of Medical Sciences, Tehran, IR Iran

2 Associated Professor, Iran University of Medical Sciences, Tehran, IR Iran

10.17795/rijm26787

Abstract

Abstract Background: Spitz Nevus is an infrequent acquired melanocytic nevus. There is still a challenge for dermatopathologists in dis- tinguishing spitz nevus from malignant melanoma particularly in adults since there is no immunohistochemistry or molecular markers which differentiate Spitz Nevus frommelanoma. Objectives: The aim of this study is to make clear what clinico-histopathological features of Spitz Nevus are in order to reduce malpractice due tomisdiagnosis. Methods: In the present study, a series of twenty two patients have been reviewed who were diagnosed with Spitz Nevous based on proved histopathology features between the years 2009 - 2013. The patients were evaluated for demographic parameters like age, sex, clinical differential diagnosis, cutaneous location of tumor, tumor diameter, subtype, symmetry,maturation, upper cleft- ing of melanocytic nest, shoulder phenomena, epidermal hyperplasia, type, kamino body,mitotic rate , inflammatory infiltration, pagetoid spread and regression. Results: In our study, 45% of patientswere younger than 10 years old. The average age of patientswas 1411.37. Male to female ratio was 1.44. The commonest location was head and neck. Spitz nevus was the first clinical differential diagnosis in 20% of patients. The commonest variant type was conventional type and then polypoid and desmoplastic types. The mean size of nevi was 0.81  0.59mm. About 59% of nevi shows epithelioid cytologic features. Other histologic parameters fromthemost to the least frequency were symmetry (100%), maturation (100%), epidermal hyperplasia (77.3%), kamino body (68.2%), subtype (compound 68%), mitotic rate (63.6%), clefting (59%), inflammatory infiltration (54.5%), pagetoid spread (18.2%), shoulder (37.5%) and regression (9.1%). Conclusions: We tried to hifhlight some clinical and histopathological features which are distinguishing Spitz nevus from other melanocytic nevi evenmalignantmelanoma.

Keywords


  1. 1.Mooi WJ, Krausz T. Spitz nevus versus spitzoid melanoma: diagnostic difficulties, conceptual controversies.Adv Anat Pathol. 2006;13(4):147– 56. [PubMed: 16858148].

    1. Rim JH, Won CH, Lee JS, Cho KH. A case of multiple disseminated eruptive Spitz nevi. J Dermatol. 2002;29(6):380–2. [PubMed: 12126078].
    2. Gantner S, Wiesner T, Cerroni L, Lurkin I, Zwarthoff EC, Landthaler M, et al. Absence of BRAF and HRAS mutations in eruptive Spitz naevi. Br J Dermatol. 2011;164(4):873–7. doi: 10.1111/j.1365-2133.2011.10210.x. [PubMed: 21418173].
    3. Levy RM, Ming ME, Shapiro M, Tucker M, Guerry D, Cirillo-Hyland VA, et al. Eruptive disseminated Spitz nevi. J Am Acad Dermatol. 2007;57(3):519–23. doi: 10.1016/j.jaad.2007.02.031. [PubMed: 17467853].
    4. Requena C, Rubio L, Traves V, Sanmartin O, Nagore E, Llombart B, et al. Fluorescence in situ hybridization for the differential diagnosis between Spitz naevus and spitzoid melanoma. Histopathology. 2012;61(5):899–909. doi: 10.1111/j.1365-2559.2012.04293.x. [PubMed: 22882594]. 6. Barnhill RL. The spitzoid lesion: the importance of atypical variants and risk assessment. Am J Dermatopathol. 2006;28(1):75–83. doi: 10.1097/01.dad.0000188868.19869.3b. [PubMed: 16456332].
    5. Lyon VB. The spitz nevus: review and update. Clin Plast Surg. 2010;37(1):21–33. doi: 10.1016/j.cps.2009.08.003. [PubMed: 19914455].
    6. Cesinaro AM, Foroni M, Sighinolfi P, Migaldi M, Trentini GP. Spitz nevus is relatively frequent in adults: a clinico-pathologic study of 247 cases related to patient’s age. Am J Dermatopathol. 2005;27(6):469–75. [PubMed: 16314701].
    7. Vollmer RT. Patient age in Spitz nevus and malignant melanoma: implication of Bayes rule for differential diagnosis. Am J Clin Pathol. 2004;121(6):872–7. doi: 10.1309/E14C-J6KR-D092-DP3M. [PubMed: 15198360].
    8. Mooi WJ. Spitz nevus and its histologic simulators. Adv Anat Pathol. 2002;9(4):209–21. [PubMed: 12072812].
    9. Fabrizi G, Massi G. Polypoid Spitz naevus: the benign counterpart of polypoid malignant melanoma. Br J Dermatol. 2000;142(1):128–32. [PubMed: 10651708].
    10. Kernen JA, Ackerman LV. Spindle cell nevi and epithelioid cell nevi (socalled juvenile melanomas) in children and adults: a clinicopathological study of 27 cases. Cancer. 1960;13:612–25. [PubMed: 14408617].
    11. Bogdanov-Berezovsky A, Rosenberg L, Cagnano E, Amrani O, Silberstein E. Clinical and pathologic features of Spitz nevus: the experience of 79 cases. Plastic Surg. 2010;7(1):2.
    12. Kamino H, Flotte TJ, Misheloff E, Greco MA, Ackerman AB. Eosinophilic globules in Spitz’s nevi. New findings and a diagnostic sign. Am J Dermatopathol. 1979;1(4):319–24. [PubMed: 94511].
    13. LeBoit PE. Kamino bodies: what they may mean. Am J Dermatopathol. 2001;23(4):374–7. [PubMed: 11481532].
    14. Weedon D, Little JH. Spindle and epithelioid cell nevi in children and adults. A review of 211 cases of the Spitz nevus. Cancer. 1977;40(1):217– 25. [PubMed: 880553].
    15. Berlingeri-Ramos AC, Morales-Burgos A, Sanchez JL, Nogales EM. Spitz nevus in a Hispanic population: a clinicopathological study of 130 cases. Am J Dermatopathol. 2010;32(3):267–75. doi: 10.1097/DAD.0b013e3181c52b99. [PubMed: 20098300].