Natural Evolution of Spitz Nevi

Argenziano, Giuseppe; Agozzino, Marina; Bonifazi, E.; Broganelli, Paolo; Brunetti, B; Ferrara, Gerardo; Fulgione, Elisabetta; Garrone, Alessandro; Zalaudek, Iris

doi:10.1159/000326109

Cited by 57 publications

(41 citation statements)

References 29 publications

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“…Pizzichetta et al also observed that after a variable number of months, lesions tended to acquire a stable homogeneous pattern. Finally, several months to a few years later, most lost their pigmentation and underwent spontaneous involution . A dermoscopic study by Argenziano et al on 64 Spitz nevi revealed that the majority of the lesions that were initially pigmented or partially pigmented during their growing phase (92.3%) became amelanotic or nonpigmented (47.1%) during their involution phase.…”

Section: Methodsmentioning

confidence: 99%

Spitz Nevi and Other Spitzoid Neoplasms in Children: Overview of Incidence Data and Diagnostic Criteria

Dika

Ravaioli

Fanti

et al. 2016

Pediatric Dermatology

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Spitz nevi are benign melanocytic neoplasms characterized by epithelioid or spindle melanocytes or both. In some rare cases their presentation overlaps with the clinical and histopathologic features of malignant melanoma, so a differential diagnosis can be difficult to make. Intermediate forms between Spitz nevi and malignant melanoma, with unpredictable behavior, have been called atypical Spitz tumors. A literature search was performed to review the clinical, dermoscopic, genetic, and histopathologic aspects of spitzoid tumors. Spitz nevi mainly occur in children, with no predilection for sex, and in young women. Common sites are the head and lower arms, where Spitz nevi present as pink nodules or hyperpigmented plaques. Spitzoid lesions may have diverse dermoscopic patterns: vascular, starburst, globular, atypical, reticular, negative homogeneous, or targetoid. The management of spitzoid lesions can be invasive or conservative; surgical excision is usually reserved for those with doubtful features, whereas clinical and dermoscopic follow-up is preferred for typical pediatric Spitz nevi. The role of sentinel lymph node biopsy in atypical Spitz tumors is debated. Immunohistochemistry and new molecular techniques such as comparative genomic hybridization, polymerase chain reaction, and fluorescence in situ hybridization offer new diagnostic perspectives, investigating genetic alterations that are specific for malignant melanoma or for Spitz nevi.

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Section: Methodsmentioning

confidence: 99%

Spitz Nevi and Other Spitzoid Neoplasms in Children: Overview of Incidence Data and Diagnostic Criteria

Dika

Ravaioli

Fanti

et al. 2016

Pediatric Dermatology

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“…Of note, our data show a significant association in these cases between IEM and intracorneal melanocytosis (p < 0.0001); furthermore, intracorneal melanocytes were relatively common in IEM-positive Spitz nevi (p = 0.0154). Regarding the high rate of spontaneous regression reported in Spitz nevi, 17,18 we surmise that intracorneal melanocytes may be an evidence of transepidermal elimination of melanocytes, which is considered as a potential route of regression. 19 Of course, macrophages can migrate into epidermis, ingest melanin there and turn into melanophages on site; however, our data suggest the intriguing possibility that some IEM may be dermal melanophages that have been transported into the epidermis together with dermal melanocytic nests during the process of transepidermal elimination of melanocytes.…”

Section: Discussionmentioning

confidence: 88%

“…Recently, the potential for spontaneous involution of Spitz nevi has been emphasized. 17,18 The mechanism of involution in Spitz nevi is still uncertain, but transepidermal elimination of melanocytes is considered as one possibility. 19 The rate of transepidermal elimination of melanocytes is reportedly greater in Spitz nevi than in non-spitzoid tumors.…”

Section: Discussionmentioning

confidence: 99%

Melanocytic tumors with intraepidermal melanophages: a report of five cases with review of 231 archived cutaneous melanocytic tumors

et al. 2015

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Dermal melanophages are frequently encountered in both benign melanocytic nevi and malignant melanoma. In contrast, intraepidermal melanophages (IEM) are under-recognized in melanocytic lesions and their biologic significance is not understood. Herein, we report the clinical and histopathologic features of five melanocytic lesions featuring IEM encountered prospectively in our dermatopathology practice at the University of Chicago. Two hundred and thirty-one (231) archived skin primary melanocytic proliferations were also investigated retrospectively in a de-identified, archival teaching set collection. Nineteen of 231 of the archived cases were positive for IEM. Among the total 24 IEM-positive cases (5 prospective and 19 archived cases), 13 were categorized as Spitz nevi (p < 0.0001) and 3 as atypical Spitz tumors (p = 0.0152). Fourteen of 24 cases with IEM also exhibited intracorneal melanocytes (p < 0.0001). IEM are evidently not rare, especially in spitzoid melanocytic neoplasms. IEM in our series were significantly correlated with intracorneal melanocytosis, possibly indicating an association between IEM and suprabasal melanocytosis and/or transepidermal elimination of melanocytes.

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“…Involution as the natural evolution of Spitz nevi on the face, extremities, and trunk has been reported [5]. In the regression of pigmented skin lesions such as melanoma, fibrosis, melanosis, and numerous telangiectasis are histopathologically observed [6], but the combination of these features is not found in Spitz nevi.…”

Section: Resultsmentioning

confidence: 99%

Spitz nevus on the sole of the foot presenting with transepidermal elimination

Kobayashi

Oishi

Miyake

et al. 2014

Dermatol Pract Concept

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A 10-year-old Japanese girl presented with a rhomboid-shaped brown macule, 4x3 mm in size, on the sole of the right foot. Dermoscopic examination revealed a number of black dots and globules on the ridges of the skin, marking an area of symmetrical brown pigmentation. On the periphery, a streak-like arrangement of black dots/globules on the brown pigmentation was observed along the ridges, simulating a “starburst” pattern. The lesion was excised and histological examination showed a symmetrical wedge-shaped compound melanocytic lesion that consisted of junctional and intradermal nests of a mixture of large spindle and epithelioid cells. None of the cells were atypical, and maturation of the cells with increasing depth was observed. From these findings, a diagnosis of Spitz nevus was made. Transepidermal elimination of nevus cell nests was observed and there were small groups of degenerated melanin-laden cells in the cornified layer. Masson Fontana stain revealed fine melanin deposits in the nevus cells of the junctional and intradermal nests, as well as heavy melanin deposits in the small groups of degenerated cells in the cornified layer. The distribution of melanin may contribute to a unique dermoscopic finding in this case.

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Natural Evolution of Spitz Nevi

Cited by 57 publications

References 29 publications

Spitz Nevi and Other Spitzoid Neoplasms in Children: Overview of Incidence Data and Diagnostic Criteria

Spitz Nevi and Other Spitzoid Neoplasms in Children: Overview of Incidence Data and Diagnostic Criteria

Melanocytic tumors with intraepidermal melanophages: a report of five cases with review of 231 archived cutaneous melanocytic tumors

Spitz nevus on the sole of the foot presenting with transepidermal elimination

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