Dermoscopy of pigmented variant of acral Spitz nevus Mario Vaccaro, MD, PhD, Francesco Borgia, MD, and Serafinella P. Cannav o, MD Messina, Italy
CLINICAL PRESENTATION A 28-year-old woman presented with a 2-month history of a rapidly growing pigmented macule on her right palm. The physical examination revealed an asymmetrical dark-brown macule on the surface of her palm that was 2.9 3 1.6 mm in size with radial extensions at the periphery (Fig 1).
Fig 1. Dark-brown macule on the right palm.
DERMOSCOPIC APPEARANCE Dermoscopy revealed a melanocytic lesion with a parallel furrow pattern and large radial projections. A regular rim of tiered globules at the periphery in a radiate distribution was also present (Fig 2).
Fig 2. Dermoscopy revealed a parallel furrow pattern with large projections and small globules at the periphery.
S11
S12 Vaccaro, Borgia, and Cannav o
J AM ACAD DERMATOL
JANUARY 2015
HISTOLOGIC DIAGNOSIS The histologic diagnosis was acral pigmented variant of Spitz nevus, characterized by the junctional proliferation of large epithelioid melanocytes with focal aspects of pagetoid intraepidermal ascent (Fig 3).
Fig 3. The histopathologic examination revealed a symmetrical lesion with nests of epithelioid melanocytes along the dermoepidermal junction and focal aspects of pagetoid intraepidermal ascent. The inset shows a higher magnification (310). (Hematoxylin-eosin stain.)
KEY MESSAGE The acral presentation of Spitz nevus is very rare, with only 2 reports occurring on the palmar surface.1,2 Spitzoid lesions may share many clinical, dermoscopic, and histologic similarities with malignant melanoma, and a careful microscopic examination is required to render the proper diagnosis. It is possible to find a multicomponent dermoscopic pattern in Spitz nevi and dermoscopic features of Spitz nevi in melanomas; the lack of an easily recognizable specific dermoscopic pattern can make it difficult to distinguish good from evil—especially on glabrous skin. Our patient had an acral nevus with a very uncommon clinical presentation. Dermoscopy revealed a peculiar combination of the typical parallel furrow pattern with large lateral projections extending from the tumor toward the surrounding normal skin, which resembled a rough starburst-like pattern. The presence of multiple rows of peripheral globules, as opposed to the single row usually observed in Clark nevi, reflects the radial growth phase of the nevus.3 The histologic finding of transepidermal migration of melanocytes, interpreted as a marker of malignancy in association with cytologic atypia, can be also observed in certain variants of benign melanocytic lesions, such as Spitz or acral nevi. Clinical and microscopic characteristics, together with the history of recent onset and fast growth, have led us to consider this lesion a variant of acral Spitz nevus.
REFERENCES 1. Banba K, Fujioka A, Takasu H, Ishibashi A, Ohta M. Spitz nevus on the palmar surface. J Dermatol 2000;27:333-6. 2. Yasuma A, Hara H, Hukuda N, Terui T. Usefulness of dermoscopy for diagnosing pigmented Spitz nevus occurring on the glabrous skin. J Eur Acad Dermatol Venereol 2006;20:1362-3. 3. Kerner M, Jaimes N, Scope A, Marghoob AA. Spitz nevi: a bridge between dermoscopic morphology and histopathology. Dermatol Clin 2013;31:327-35.
From the Department of Clinical and Experimental Medicine, Dermatology, University of Messina. Publication of this article was supported by 3Gen. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Mario Vaccaro, MD, PhD, Department of Clinical and Experimental Medicine, Dermatology, University
of Messina, Via C. Valeria, Gazzi, 98125 Messina, Italy. E-mail: [email protected]. J Am Acad Dermatol 2015;72:S11-2. 0190-9622/$36.00 ª 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.03.036
CLINICAL PRESENTATION A 28-year-old woman presented with a 2-month history of a rapidly growing pigmented macule on her right palm. The physical examination revealed an asymmetrical dark-brown macule on the surface of her palm that was 2.9 3 1.6 mm in size with radial extensions at the periphery (Fig 1).
Fig 1. Dark-brown macule on the right palm.
DERMOSCOPIC APPEARANCE Dermoscopy revealed a melanocytic lesion with a parallel furrow pattern and large radial projections. A regular rim of tiered globules at the periphery in a radiate distribution was also present (Fig 2).
Fig 2. Dermoscopy revealed a parallel furrow pattern with large projections and small globules at the periphery.
S11
S12 Vaccaro, Borgia, and Cannav o
J AM ACAD DERMATOL
JANUARY 2015
HISTOLOGIC DIAGNOSIS The histologic diagnosis was acral pigmented variant of Spitz nevus, characterized by the junctional proliferation of large epithelioid melanocytes with focal aspects of pagetoid intraepidermal ascent (Fig 3).
Fig 3. The histopathologic examination revealed a symmetrical lesion with nests of epithelioid melanocytes along the dermoepidermal junction and focal aspects of pagetoid intraepidermal ascent. The inset shows a higher magnification (310). (Hematoxylin-eosin stain.)
KEY MESSAGE The acral presentation of Spitz nevus is very rare, with only 2 reports occurring on the palmar surface.1,2 Spitzoid lesions may share many clinical, dermoscopic, and histologic similarities with malignant melanoma, and a careful microscopic examination is required to render the proper diagnosis. It is possible to find a multicomponent dermoscopic pattern in Spitz nevi and dermoscopic features of Spitz nevi in melanomas; the lack of an easily recognizable specific dermoscopic pattern can make it difficult to distinguish good from evil—especially on glabrous skin. Our patient had an acral nevus with a very uncommon clinical presentation. Dermoscopy revealed a peculiar combination of the typical parallel furrow pattern with large lateral projections extending from the tumor toward the surrounding normal skin, which resembled a rough starburst-like pattern. The presence of multiple rows of peripheral globules, as opposed to the single row usually observed in Clark nevi, reflects the radial growth phase of the nevus.3 The histologic finding of transepidermal migration of melanocytes, interpreted as a marker of malignancy in association with cytologic atypia, can be also observed in certain variants of benign melanocytic lesions, such as Spitz or acral nevi. Clinical and microscopic characteristics, together with the history of recent onset and fast growth, have led us to consider this lesion a variant of acral Spitz nevus.
REFERENCES 1. Banba K, Fujioka A, Takasu H, Ishibashi A, Ohta M. Spitz nevus on the palmar surface. J Dermatol 2000;27:333-6. 2. Yasuma A, Hara H, Hukuda N, Terui T. Usefulness of dermoscopy for diagnosing pigmented Spitz nevus occurring on the glabrous skin. J Eur Acad Dermatol Venereol 2006;20:1362-3. 3. Kerner M, Jaimes N, Scope A, Marghoob AA. Spitz nevi: a bridge between dermoscopic morphology and histopathology. Dermatol Clin 2013;31:327-35.
From the Department of Clinical and Experimental Medicine, Dermatology, University of Messina. Publication of this article was supported by 3Gen. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Mario Vaccaro, MD, PhD, Department of Clinical and Experimental Medicine, Dermatology, University
of Messina, Via C. Valeria, Gazzi, 98125 Messina, Italy. E-mail: [email protected]. J Am Acad Dermatol 2015;72:S11-2. 0190-9622/$36.00 ª 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.03.036
