Case Number : Case 2626 - 30 July 2020 Posted By: Saleem Taibjee

Looks like compound Spitz nevus, but the patient’s age worries me.

Spitzoid tumor, probably Spitz Nevus. 
 

Looks Spitz nevus (beautiful Kamino bodies). For age purposes and the history of changing lesion, I think I will do P16 and I may consider FISH too. 

2 hours ago, Dr. Mona Abdel-Halim said:

Looks Spitz nevus (beautiful Kamino bodies). For age purposes and the history of changing lesion, I think I will do P16 and I may consider FISH too. 

Agree.

Looks like compound spitz nevus. 

Spitz nevus

Interesting discussion, it seems that it was worthwhile posting this case.

For me this is a typical Spitz naevus histologically. Various supportive features; nice lateral demarcation, transepidermal elimination of nests, good maturation with depth, no dermal mitoses.

And to top it all, perhaps the best example of Kamino bodies I have personally come across.

So then the question/discussion arises, how much does / should age alter our approach and management? I must admit that I have signed this case out without any ancillary investigations (e.g. p16 immunohistochemistry, FISH, etc). Bearing in mind that there are examples of typical naevi with loss of p16 on IHC, etc, and there is a cost associated with FISH which becomes relevant for our National Health Service with limited resources.

For those who wish to re-visit Kamino bodies, please refer to the original description. Kamino H, et al. Eosinophilic globules in Spitz’s nevi. Am J Dermatopathol 1979;1:319-24, and the interesting editorial article LeBoit PE. Kamino bodies: What they may mean. Am J Dermatopathol 2001;23:374-7. In the latter, Phil LeBoit challenges the readership to find a clear-cut melanoma with genuine Kamino bodies (as opposed to dyskeratotic keratinocytes). I am yet to see such a case myself.

Fully agree with Saleem. I’m an old general pathologist and in the pre-immunohistochemistry age I made a Spitz Nevus diagnosis in similar cases feeling comfortable. We should not overdo the modernity. 

Spitz nevus

Spitz nevus