Difference between revisions of "Spitz nevus"

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#redirect [[Melanocytic_lesions#Spitz_nevus]]
'''Spitz nevus''', also known as ''epithelioid and spindle-cell nevus''', is an uncommon [[melanocytic lesion]] that can be difficult to differentiate from [[malignant melanoma]].
 
==General==
*May be very difficult to differentiate from [[melanoma]].
 
Epidemiology:
*Children & adolescents.
 
Treatment:
*Complete excision.<ref name=pmid12140468>{{Cite journal  | last1 = Gelbard | first1 = SN. | last2 = Tripp | first2 = JM. | last3 = Marghoob | first3 = AA. | last4 = Kopf | first4 = AW. | last5 = Koenig | first5 = KL. | last6 = Kim | first6 = JY. | last7 = Bart | first7 = RS. | title = Management of Spitz nevi: a survey of dermatologists in the United States. | journal = J Am Acad Dermatol | volume = 47 | issue = 2 | pages = 224-30 | month = Aug | year = 2002 | doi =  | PMID = 12140468 }}</ref>
 
==Gross==
*Usually face ''or'' extremity.<ref name=Ref_Derm449>{{Ref Derm|449}}</ref>
 
==Microscopic==
Features:<ref name=Ref_WMSP499>{{Ref WMSP|499}}</ref>
*Architecture:
**Nests of cells (spindle, epithelioid or spindle/epithelioid) - in both dermis and epidermis.
***Nests are vertically arranged, i.e. the long axis of the nests are perpendicular to the skin surface.
****Nest arrangement/orientation described as "cluster of bananas".
*+/-Hyperkeratosis (more keratin, i.e. thick stratum corneum).
*+/-Hypergranulosis (thick stratum granulosum).
*+/-[[Acanthosis]] (thick stratum spinosum).
*Kamino bodies (also written ''Camino bodies'') - dense eosinophilic bodies.<ref name=PMC2797485>{{Cite journal  | last1 = Kirkwood | first1 = John M. | last2 = Jukic | first2 = Drazen | last3 = Averbook | first3 = Bruce J. | last4 = Sender | first4 = Leonard S. | title = Melanoma in Pediatric, Adolescent, and Young Adult Patients | journal = Semin Oncol. | volume = 36 | issue = 5 | pages = 419-31 | month = October | year = 2009 | doi =  | PMID =  | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797485/?tool=pmcentrez |PMC = 2797485 }}</ref>
**Apoptotic cells.
**Kamino bodies are rare in melanoma.
 
Notes:
*'''Never''' in the setting of [[solar elastosis]].<ref>Jakubovic, H. 16 July 2010.</ref>
**If there is solar elastosis -- it's melanoma.
 
DDx:
*[[Malignant melanoma]] - so-called ''Spitzoid melanoma''.
*[[Pigmented spindle cell nevus of Reed]].
 
===Images===
<gallery>
Image:Spitz_nevus_-_low_mag.jpg | Spitz nevus - low mag. (WC)
Image:Spitz_nevus_-_intermed_mag.jpg | Spitz nevus - intermed. mag. (WC)
Image:Spitz_nevus_-_high_mag.jpg | Spitz nevus - high mag. (WC)
</gallery>
www:
*[http://www.drmihm.com/cases/case.cfm?CaseID=51 Spitz nevus - collection of images (drmihm.com)].
*[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=006734 Spitz nevus with arrow to camino body (unibas.ch)].
 
==IHC==
*HMB-45 -ve at deep aspect.
*Ki-67 low.
 
==See also==
*[[Melanocytic lesions]].
*[[Malignant melanoma]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Melanocytic lesions]]

Revision as of 01:18, 6 December 2013

'Spitz nevus, also known as epithelioid and spindle-cell nevus, is an uncommon melanocytic lesion that can be difficult to differentiate from malignant melanoma.

General

  • May be very difficult to differentiate from melanoma.

Epidemiology:

  • Children & adolescents.

Treatment:

  • Complete excision.[1]

Gross

  • Usually face or extremity.[2]

Microscopic

Features:[3]

  • Architecture:
    • Nests of cells (spindle, epithelioid or spindle/epithelioid) - in both dermis and epidermis.
      • Nests are vertically arranged, i.e. the long axis of the nests are perpendicular to the skin surface.
        • Nest arrangement/orientation described as "cluster of bananas".
  • +/-Hyperkeratosis (more keratin, i.e. thick stratum corneum).
  • +/-Hypergranulosis (thick stratum granulosum).
  • +/-Acanthosis (thick stratum spinosum).
  • Kamino bodies (also written Camino bodies) - dense eosinophilic bodies.[4]
    • Apoptotic cells.
    • Kamino bodies are rare in melanoma.

Notes:

DDx:

Images

  • Spitz nevus - low mag. (WC)

  • Spitz nevus - intermed. mag. (WC)

  • Spitz nevus - high mag. (WC)

www:

IHC

  • HMB-45 -ve at deep aspect.
  • Ki-67 low.

See also

References

  1. ↑ Gelbard, SN.; Tripp, JM.; Marghoob, AA.; Kopf, AW.; Koenig, KL.; Kim, JY.; Bart, RS. (Aug 2002). "Management of Spitz nevi: a survey of dermatologists in the United States.". J Am Acad Dermatol 47 (2): 224-30. PMID 12140468.
  2. ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 449. ISBN 978-0443066542.
  3. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 499. ISBN 978-0781765275.
  4. ↑ Kirkwood, John M.; Jukic, Drazen; Averbook, Bruce J.; Sender, Leonard S. (October 2009). "Melanoma in Pediatric, Adolescent, and Young Adult Patients". Semin Oncol. 36 (5): 419-31. PMC 2797485. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797485/.
  5. ↑ Jakubovic, H. 16 July 2010.
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