Case Number : Case 370 Posted By: Guest

Peter Karolyi - () Wrote:

It was an extremely imortant, instructive case and explanation, thanks very much.

Submitted on 10/11/2011 03:13
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Phillip McKee - Overseas Consultations (Cave Creek, Arizona, USA) Wrote:

This case has certainly proved to be a challenge. Firstly, I think that the lesion lacks symmetry i.e. the left and right sides do not match up. The innumerable nests are expansile, devoid of a retraction artifact and there is no lack of cohesion. I do not think that the tumor cell population looks particularly spitzoid. There is pagetoid spread and nests are present in clusters throughout the epidermis almost to and focally involving the granular cell layer. I diagnosed this lesion as in situ superficial spreading melanoma.

Submitted on 09/11/2011 11:56
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

I think it is Spitz nevus

Submitted on 09/11/2011 08:34
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Diana Alvarez - () Wrote:

Spitz nevus (junctional)

Submitted on 09/11/2011 08:04
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Marcela Saeb Lima - INCMNSZ (Mexico City) Wrote:

Dear Peter, I undertand the criteria you are applying for symmetry, however, you do think there is "certain" but not "very" asymmetrical? What I was trying to say is that at the edges there is no junctional component, in the sense of lateral or radial growth phase... thank you!

Submitted on 09/11/2011 07:51
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Rodrigo Restrepo - UPB/CES (Mdlln/Col) Wrote:

Spitz naevus (pagetoid)

Submitted on 09/11/2011 07:35
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Anh Tran - Florida Hospital Orlando (Orlando) Wrote:

Also,I don't see a lot of atypical melanocytes arranged in single units along the dermal-epidermal junction, so it's probably a Spitz nevus. But how should we sign out this lesion in practice?

Submitted on 09/11/2011 07:19
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Peter Karolyi - Karolinska, Sweden () Wrote:

Dear Marcela, it is a good question if this is a symmetrical lesion or not (fig 1). Symmetricity in a skin tumor is not a well reproducible category. In this case I see certain asymmetry, but the whole picture is benign.

Submitted on 09/11/2011 06:05
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A Bansal - BCU HB (North Wales) Wrote:

Spitz naevus (junctional)

Submitted on 09/11/2011 05:49
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Mona Abdel Halim - Dermatology Dept. Cairo Univ. (Egypt) Wrote:

I also think it is a pgetoid spitz nevus, no worrisome features,,

Submitted on 09/11/2011 05:40
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Marcela Saeb Lima - INCMNSZ (Mexico City) Wrote:

It is a symmetrical pigmented melanocytic lesion with spitzoid features and transepidermal elimination of cells. I do not see Kamino bodies. There is no mitotic activity, and all the cells look similar. The lesion is widely excised. The age and the location of the lesion is of risk to think in melanoma. However, there are more features to consider the lesion a pagetoid Spitz nevus.

Submitted on 09/11/2011 05:28
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Peter Karolyi - Karolinska Sweden () Wrote:

My first imression is that it is a Spitz-tumor with pagetoid spread. No mitotic activity, I do not think it is malignant.

Submitted on 09/11/2011 05:00