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

Abstract

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.

Acral pigmented Spitz nevus in a child with transepidermal migration of melanocytes: Dermoscopic and reflectance confocal microscopic features

“…The lesion was ultimately excised and determined to be a benign pigmented acral Spitz nevus. Acral nevi may also demonstrate transepidermal elimination of melanocytes, as noted in the case of a 10‐year‐old Japanese girl with a pigmented plantar lesion . This histologic finding is often associated with malignancy but has also been described in benign acral melanocytic nevi .…”

“…year-old Japanese girl with a pigmented plantar lesion. 10 This histologic finding is often associated with malignancy but has also been described in benign acral melanocytic nevi. 11 In addition, histologic analysis of 158 acral melanocytic neoplasms found that the mere presence of pagetoid spread was insufficient to make a diagnosis of melanoma.…”

Angiomatoid Spitz nevus with surrounding pagetoid melanocytic proliferation on the sole of the foot: An unusual case report with immunohistochemical studies for angiogenic factors

“…Some cases showed a starburst pattern, peripheral radial pigmentation frequently seen in SN of the non‐volar skin . Others also showed dominant pigmentation on the ridge, which may be suggestive of malignant melanoma . The heavy pigmentation in these cases might have been caused by heavy melanin deposits produced by large tumor nests of SN .…”

“…7,8 Others also showed dominant pigmentation on the ridge, which may be suggestive of malignant melanoma. 7,9 The heavy pigmentation in these cases might have been caused by heavy melanin deposits produced by large tumor nests of SN. 7 However, the macule in our case showed pagetoid melanocytic proliferation without formation of tumor nests causing heavy melanin deposits, and dermoscopy revealed relatively light, dotted linear pigmentation, some of which was distributed along either or both sides of the sulcus.…”

A case of perforating dermatofibroma with floret-like giant cells

“…Diabetic vasculopathy induces a hypoxic state, in which the trauma from scratching causes dermal necrosis . In addition, Kobayashi et al . reported a case of Spitz naevus with transepidermal elimination, explaining this phenomenon as the mechanism of involution of the naevus.…”