T. Shulaia1, N. Kiladze2, A. Miriamidze3
1Medical Center ″Marjani″
2Tbilisi State Medical University
3Pathology Research Center
Introduction. S. Spitz nevus is a benign melanocytic neoplasm composed from spindled or epitheloid new melanocytes mostly appearing in the pediatric age and described previously as juvenile melanoma. In accordance with the literature the majority of cases are observed in the first two decades of life mainly in fair-skinned persons representing about 1.0 % of all childhood melanocytic nevi. The S. Spitz nevus was first described in 1948 by Sophie Spitz as benign juvenile melanoma with good prognosis but histological resemblance with melanoma and bears her name. It may mimic melanoma at clinical, dermatoscopic and histopathological levels being today the subject of discussion and one of the most difficult questions among the pigmented lesions both for dermatologists and morphologists. As a result, there are contradictions regarding the appropriate therapy and prognosis.
The aim of the study. To describe the correlations between the clinical, dermatoscopic and pathomorphological features of S. Spitz nevi in three clinical cases.
Materials and methods. The content analysis, bibliosemantic method of studying the actual scientific researches concerning non-invasive methods of S. Spitz nevus evaluation were used. The study was carried out in the following scientific databases: PubMed-NCBI, Medline, Cochranel Library, EMBASE, ReseachGate by keywords: S. Spitz nevus, dermatoscopy, correlation with morphological examination. Three clinical cases were described. Digital dermatoscopic images were captured using Dermatoscope (DermLite DL3) mounted on the digital camera Galaxy S-4 Samsung Corporation) using the ultrasound gel for imersion dermatoscopy. All images were evaluated in accordance with algorithm of H. Kittler.
Results. Dermatoscopy is the appropriate and helpful method for diagnosing S. Spitz nevus, but together with this the histopathological and immunohistochemical examinations are still needed to rule out malignancy, especially for uncommon or atypical dermatoscopic patterns. S. Spitz nevus clinically is presented as a solitary, pink, red or brown papule most commonly located on the face or extremities and characterized by an initially rapid growth. The other clinical characteristic feature is size, thus they are usually less than 1.0 cm in diameter, larger size is considered as abnormal. They may be pigmented when colours ranging from tan to dark brown or even black, but typically they are from pink to red because of limited melanin content and increased vascularity. Clinically the most often features are symmetry, smooth, dome-shaped and hairless surface, and well-demarcated borders. Both genders are equally affected. However, because of few specific clinical features, it is often difficult to make a correct diagnosis of S. Spitz nevus with naked eyes, sometimes it is clinically mistaken with other skin tumors such as hemangioma, verruca vulgaris, dermatofibroma, etc. Dermatoscopy became very helpful in S. Spitz nevus diagnosis accuracy and its most typical variants determining. The management of S. Spitz nevus is still controversial. According to dermatoscopic morphology of S. Spitz nevi and management guidelines by 2017 British Association of Dermatologists, surgical excision should be reserved for suspicious lesions in children at 12 years of age and older and for all suspicious neoplasm with an atypical pattern when malignant melanoma cannot be excluded in children of all ages. Clinical and dermatoscopic follow-up should be continued until these neoplasms maintain the typical features of common nevi or disappear. In this report we discuss 3 different cases of S. Spitz nevi. The patients were at the age of 7 to 11 years old, had unremarkable medical histories and rapid growth of elements in the last period.
Conclusions. There are many contradictions in the diagnosis and management of S. Spitz nevus due to its peculiar clinical, dermatoscopic and histomorphological features. Dermatoscopy has emerged as an important tool in the evaluation of patients with such lesions, but it is still necessary to perform a biopsy or excision for cases with suspicious clinical manifestations or atypical dermatoscopic patterns. As well the short-term follow-up is helpful and should be continued until these neoplasms maintain the typical features of common nevi or disappear.
- Argenziano G, Scalvenzi M, Brunetti B et al. Dermatoscopic pitfalls in differentiating pigmented Spitz naevi from cutaneous melanomas. Br J Dermatol. 1999;141(5):788-793.
- Argenziano G, Soyer HP, Ferrara G et al. Superficial black network: an additional dermoscopic clue for the diagnisis of spindle and/or epithelioid cell nevus. Dermatology 2001;203:333-335.
- Emiroglu N, Yıldız P, Biyik OD et al. Evolution of Spitz nevi. PediatrDermatol 2017;34(4):438-445.
- Dal Pozzo V, Benelli C, Restano L. Clinical review of 247 case records of Spitz Nevus (epitheliod cell and/or spindle cell nevus). Dermatology. 1997;194:20-25.
- Ferrara G, Cavicchini S, Corradin MT. Hypopigmented atypical spitzoid neoplasms (atypical Spitz nevi, atypical Spitz tumors, spitzoid melanoma): a clinicopathological update. Dermatol Pract Concept. 2015;5(1):45-52.
- 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.
- Moscarella E, Lallas A, Kyrgidis A. Clinical and dermoscopic features of atypical Spitz tumors: a multicenter, retrospective, case-control study. J Am Acad Dermatol. 2015;73(5):777-784.
- Spitz S. Melanomas of childhood. Am J Pathol. 1948;24:591-609.
- Verzi AE, Quan VL, Walton KE, Martini MC, Marghoob AA, Garfield EM et al. The diagnostic value and histologic correlate of distinct patterns of shiny white streaks for the diagnosis of melanoma: A retrospective, case-control study. J Am Acad Dermatol. 2018;78:913-919.