Case Number : Case 1692 - 22 November - Dr Uma Sundram Posted By: Guest

A lovely set of images for you today from Dr Uma Sundram.

Geoff Cross - DermpathPRO Projects

Spitz nevus.

my opinion is for Spitz nevus; is almost well circumscribed with shouldering, irregular acanthosis, thinned rete ridges, melanocitic confluence, little bit of asymetrical nested and epidermal consumption, kamino bodies, discohesive nests and pagetoid spread. The dermal component is made by cords and nests of melanocytes that shows deep maduration.

Spitz nevus.

The more atypical features of this lesion are in the right half ( pagetoid spreading of melanocytes ), where dermis looks like sclerosing/cicatricial, so I think of a Spitz Nevus, with sclerosing/recurrent-like features.

I have a different impression. I would call this lesion a compound nevus with architectural and cytological atypia of the junctional component (Dysplastic or atypia associated with a flexural site), margins free. Although there are some areas of the junctional component reminiscent of Spitz nevi (spaces around nests, pagetoid spread) I dont find them enough for this dx. In addition the intadermal component looks completely different (banal nevus) with really small melanocytes. I ultimately agree that this lesion does not look like melanoma

Combined nevus (common melanocytic nevus beneath to Spitz nevus), or melanocytic nevus with phenotypic heterogeneity, according to Barnhill’s terminology.

Melanocytic nevus (combined) > Spitz nevus 

Combined spitz and banal nevus is my impression.

Spitz naevus. Has some features of a SPARK. There is some confluence of nests in parts of the junctional proliferation. The low power images show foci of fine dermal scarring, right half of the lesion, possibly secondary to trauma. 

Spitz naevus or combined Spitz/naevocellular naevus with focal dermal scarring. Margin a little close but could adopt watchful waiting I think.

We too went with combined Spitz and ordinary nevus. We made no outright recommendations and left it in the hands of the clinician/patient; ultimately the patient decided to have the lesion re excised.