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Hypopigmented atypical Spitzoid neoplasms (atypical Spitz nevi, atypical Spitz tumors, Spitzoid melanoma): a clinicopathological update.

Ferrara G, Cavicchini S, Corradin MT - Dermatol Pract Concept (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Oncology, Anatomic Pathology Unit, Gaetano Rummo Hospital, Benevento, Italy.

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During the following forty years, however, the entity described by Sophie Spitz was thought to be completely benign, with metastasizing cases being intuitively considered as cases of melanomas simulating Spitz nevus (Spitzoid melanoma)... We have already pointed out that dermoscopy seems to allow clinicians to increasingly identify and excise pigmented spindle cell Spitz nevus and Reed nevus (which are basically the same clinicopathological entity), to such an extent that the brown-black plaque-like “variant” is surprisingly becoming the most common (and therefore “typical”) Spitz nevus encountered in clinico-dermoscopic-pathologic studies... The present paper will focus on the clinicopathological features of papulonodular hypopigmented Spitzoid lesions, which are “atypical” with a much greater frequency than their plaque-like heavily pigmented counterpart... According to this view, the adjective “atypical” is redundant and useless, because any Spitz nevus is “atypical” by definition; nevertheless, it can be differentiated from its malignant simulator (i.e., Spitzoid melanoma) according to a well defined set of histologic criteria; every Spitzoid (and non-Spitzoid) melanocytic proliferation behaves as either a benign or a malignant neoplasm which we can be unable to correctly categorize simply because our brain can fail to correctly apply the diagnostic criteria... The first problem is purely morphologic: by assuming that Spitz nevus is a simulator of melanoma (Spitz nevus as a pseudomalignancy) and that melanoma resembling Spitz nevus is a simulator of its simulator (Spitzoid melanoma as a pseudo-pseudomalignancy), it is not surprising that the diagnosis of such lesions is a quandary even among experts who may be indeed unable to place an “I don’t know” lesion into a either “nevus” or “melanoma” category... The following sections will focus on hypopigmented Spitzoid lesions; nevertheless, the above-specified algorithm must be implemented for all Spitzoid lesions, irrespective of the amount of their pigmentation... A hypopigmented Spitzoid melanocytic neoplasm can be typified by at least one of the following:Homogeneous pink color: sometimes associated with a brownish hue or remnant(s) of brown pigmentation... In our experience, a diagnosis of Spitz nevus in the presence of a polymorphous vascular pattern must be made only under a compelling histopathological evidence of benignity; we have also suggested that when a given Spitzoid lesion is histopathologically atypical but its “grading” is uncertain, the presence of a highly atypical vascular pattern could point toward its management as a “tumor” instead of an “atypical nevus”... On the excision specimen, the “shoulder” of the neoplasm disclosed a bland morphology, featuring monomorphic spindle cells, probably representing a benign background (Spitz nevus) in which Spitzoid melanoma had been developing... The prognosis of Spitz tumors is age-dependent... Adult patients, who are expected to be at greater risk, could be managed more aggressively... The suggested management for both pediatric-type and adult-type Spitzoid melanoma is obviously the same as for “conventional” melanoma... The introduction of dermoscopy has significantly changed the clinical diorama of Spitzoid lesions... Since there are still many controversial points in the histopathologic categorization of these lesions, clinicopathologic correlation must be the mainstay for their diagnosis and proper management.

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Related in: MedlinePlus

An atypical neoplasm of the face in an 11-year-old girl. Dermoscopically (A) the lesion is biphasic: a flat portion shows reticular depigmentation along with structureless and globular brown areas; a nodular area discloses a non-descript vascular pattern, featuring a diffuse reddish area. The lesion was clinically diagnosed as a pyogenic granuloma associated with a Spitz nevus. For aesthetic reasons, the nodular portion was thus curetted. Histopathologically, the nodule showed a widespread derma atrophy (B) with large sheets of epithelioid cells at the junction (C); cytomorphologically, dermal melanocytes were epithelioid but devoid of true ‘Spitzoid’ features (D). The excision specimen showed a bland junctional proliferation of spindle cells (E), which were clearly different from epithelioid melanocytes of the previously curetted nodule (F). Histopathological diagnosis: melanoma according to Ackerman’s classification [8]; Spitzoid melanoma according to Barnhill’s classification, 2006 [19]. Our histopathological diagnosis was pediatric Spitzoid melanoma (melanoma over a Spitz nevus). The dermoscopic differential diagnosis between pyogenic granuloma and nodular melanoma is virtually impossible; nevertheless, histopathologically we have never seen a pyogenic granuloma associated with a melanocytic nevus. (Copyright: ©2015 Ferrara et al.)
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f6-dp0501a06: An atypical neoplasm of the face in an 11-year-old girl. Dermoscopically (A) the lesion is biphasic: a flat portion shows reticular depigmentation along with structureless and globular brown areas; a nodular area discloses a non-descript vascular pattern, featuring a diffuse reddish area. The lesion was clinically diagnosed as a pyogenic granuloma associated with a Spitz nevus. For aesthetic reasons, the nodular portion was thus curetted. Histopathologically, the nodule showed a widespread derma atrophy (B) with large sheets of epithelioid cells at the junction (C); cytomorphologically, dermal melanocytes were epithelioid but devoid of true ‘Spitzoid’ features (D). The excision specimen showed a bland junctional proliferation of spindle cells (E), which were clearly different from epithelioid melanocytes of the previously curetted nodule (F). Histopathological diagnosis: melanoma according to Ackerman’s classification [8]; Spitzoid melanoma according to Barnhill’s classification, 2006 [19]. Our histopathological diagnosis was pediatric Spitzoid melanoma (melanoma over a Spitz nevus). The dermoscopic differential diagnosis between pyogenic granuloma and nodular melanoma is virtually impossible; nevertheless, histopathologically we have never seen a pyogenic granuloma associated with a melanocytic nevus. (Copyright: ©2015 Ferrara et al.)

Mentions: While adult Spitzoid melanoma is often clinically and dermoscopically indistingiuishable from “conventional” melanoma, pediatric Spitzoid melanoma shows very peculiar clinicopathologic features. Histopathologically, it differs from atypical Spitz nevus or Spitz tumor by showing a non-Spitzoid cytomorphologic clone arising in the context of a Spitzoid lesion. Such a highly unusual occurrence can be detected even clinically and dermoscopically. In Figure 6 the “clone” is the red nodule with a nondescript vascular pattern; the nodule was initially treated as per pyogenic granuloma, but histopathologically disclosed a highly atypical proliferation of pleomorphic epithelioid cells. On the excision specimen, the “shoulder” of the neoplasm disclosed a bland morphology, featuring monomorphic spindle cells, probably representing a benign background (Spitz nevus) in which Spitzoid melanoma had been developing. Based on the very few exceptional cases we have seen, pediatric Spitzoid melanoma is a malignancy arising in the background of a Spitz nevus [17], just like already suggested for melanoma arising in Spitz tumor [29].


Hypopigmented atypical Spitzoid neoplasms (atypical Spitz nevi, atypical Spitz tumors, Spitzoid melanoma): a clinicopathological update.

Ferrara G, Cavicchini S, Corradin MT - Dermatol Pract Concept (2015)

An atypical neoplasm of the face in an 11-year-old girl. Dermoscopically (A) the lesion is biphasic: a flat portion shows reticular depigmentation along with structureless and globular brown areas; a nodular area discloses a non-descript vascular pattern, featuring a diffuse reddish area. The lesion was clinically diagnosed as a pyogenic granuloma associated with a Spitz nevus. For aesthetic reasons, the nodular portion was thus curetted. Histopathologically, the nodule showed a widespread derma atrophy (B) with large sheets of epithelioid cells at the junction (C); cytomorphologically, dermal melanocytes were epithelioid but devoid of true ‘Spitzoid’ features (D). The excision specimen showed a bland junctional proliferation of spindle cells (E), which were clearly different from epithelioid melanocytes of the previously curetted nodule (F). Histopathological diagnosis: melanoma according to Ackerman’s classification [8]; Spitzoid melanoma according to Barnhill’s classification, 2006 [19]. Our histopathological diagnosis was pediatric Spitzoid melanoma (melanoma over a Spitz nevus). The dermoscopic differential diagnosis between pyogenic granuloma and nodular melanoma is virtually impossible; nevertheless, histopathologically we have never seen a pyogenic granuloma associated with a melanocytic nevus. (Copyright: ©2015 Ferrara et al.)
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4325689&req=5

f6-dp0501a06: An atypical neoplasm of the face in an 11-year-old girl. Dermoscopically (A) the lesion is biphasic: a flat portion shows reticular depigmentation along with structureless and globular brown areas; a nodular area discloses a non-descript vascular pattern, featuring a diffuse reddish area. The lesion was clinically diagnosed as a pyogenic granuloma associated with a Spitz nevus. For aesthetic reasons, the nodular portion was thus curetted. Histopathologically, the nodule showed a widespread derma atrophy (B) with large sheets of epithelioid cells at the junction (C); cytomorphologically, dermal melanocytes were epithelioid but devoid of true ‘Spitzoid’ features (D). The excision specimen showed a bland junctional proliferation of spindle cells (E), which were clearly different from epithelioid melanocytes of the previously curetted nodule (F). Histopathological diagnosis: melanoma according to Ackerman’s classification [8]; Spitzoid melanoma according to Barnhill’s classification, 2006 [19]. Our histopathological diagnosis was pediatric Spitzoid melanoma (melanoma over a Spitz nevus). The dermoscopic differential diagnosis between pyogenic granuloma and nodular melanoma is virtually impossible; nevertheless, histopathologically we have never seen a pyogenic granuloma associated with a melanocytic nevus. (Copyright: ©2015 Ferrara et al.)
Mentions: While adult Spitzoid melanoma is often clinically and dermoscopically indistingiuishable from “conventional” melanoma, pediatric Spitzoid melanoma shows very peculiar clinicopathologic features. Histopathologically, it differs from atypical Spitz nevus or Spitz tumor by showing a non-Spitzoid cytomorphologic clone arising in the context of a Spitzoid lesion. Such a highly unusual occurrence can be detected even clinically and dermoscopically. In Figure 6 the “clone” is the red nodule with a nondescript vascular pattern; the nodule was initially treated as per pyogenic granuloma, but histopathologically disclosed a highly atypical proliferation of pleomorphic epithelioid cells. On the excision specimen, the “shoulder” of the neoplasm disclosed a bland morphology, featuring monomorphic spindle cells, probably representing a benign background (Spitz nevus) in which Spitzoid melanoma had been developing. Based on the very few exceptional cases we have seen, pediatric Spitzoid melanoma is a malignancy arising in the background of a Spitz nevus [17], just like already suggested for melanoma arising in Spitz tumor [29].

View Article: PubMed Central - PubMed

Affiliation: Department of Oncology, Anatomic Pathology Unit, Gaetano Rummo Hospital, Benevento, Italy.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

During the following forty years, however, the entity described by Sophie Spitz was thought to be completely benign, with metastasizing cases being intuitively considered as cases of melanomas simulating Spitz nevus (Spitzoid melanoma)... We have already pointed out that dermoscopy seems to allow clinicians to increasingly identify and excise pigmented spindle cell Spitz nevus and Reed nevus (which are basically the same clinicopathological entity), to such an extent that the brown-black plaque-like “variant” is surprisingly becoming the most common (and therefore “typical”) Spitz nevus encountered in clinico-dermoscopic-pathologic studies... The present paper will focus on the clinicopathological features of papulonodular hypopigmented Spitzoid lesions, which are “atypical” with a much greater frequency than their plaque-like heavily pigmented counterpart... According to this view, the adjective “atypical” is redundant and useless, because any Spitz nevus is “atypical” by definition; nevertheless, it can be differentiated from its malignant simulator (i.e., Spitzoid melanoma) according to a well defined set of histologic criteria; every Spitzoid (and non-Spitzoid) melanocytic proliferation behaves as either a benign or a malignant neoplasm which we can be unable to correctly categorize simply because our brain can fail to correctly apply the diagnostic criteria... The first problem is purely morphologic: by assuming that Spitz nevus is a simulator of melanoma (Spitz nevus as a pseudomalignancy) and that melanoma resembling Spitz nevus is a simulator of its simulator (Spitzoid melanoma as a pseudo-pseudomalignancy), it is not surprising that the diagnosis of such lesions is a quandary even among experts who may be indeed unable to place an “I don’t know” lesion into a either “nevus” or “melanoma” category... The following sections will focus on hypopigmented Spitzoid lesions; nevertheless, the above-specified algorithm must be implemented for all Spitzoid lesions, irrespective of the amount of their pigmentation... A hypopigmented Spitzoid melanocytic neoplasm can be typified by at least one of the following:Homogeneous pink color: sometimes associated with a brownish hue or remnant(s) of brown pigmentation... In our experience, a diagnosis of Spitz nevus in the presence of a polymorphous vascular pattern must be made only under a compelling histopathological evidence of benignity; we have also suggested that when a given Spitzoid lesion is histopathologically atypical but its “grading” is uncertain, the presence of a highly atypical vascular pattern could point toward its management as a “tumor” instead of an “atypical nevus”... On the excision specimen, the “shoulder” of the neoplasm disclosed a bland morphology, featuring monomorphic spindle cells, probably representing a benign background (Spitz nevus) in which Spitzoid melanoma had been developing... The prognosis of Spitz tumors is age-dependent... Adult patients, who are expected to be at greater risk, could be managed more aggressively... The suggested management for both pediatric-type and adult-type Spitzoid melanoma is obviously the same as for “conventional” melanoma... The introduction of dermoscopy has significantly changed the clinical diorama of Spitzoid lesions... Since there are still many controversial points in the histopathologic categorization of these lesions, clinicopathologic correlation must be the mainstay for their diagnosis and proper management.

No MeSH data available.


Related in: MedlinePlus