Difference between revisions of "Spitz nevus"

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'''Spitz nevus''', also known as ''epithelioid and spindle-cell nevus''', is an uncommon [[melanocytic lesion]] that can be difficult to differentiate from [[malignant melanoma]].
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Spitz_nevus_-_high_mag.jpg
| Width      =
| Caption    = Spitz nevus. [[H&E stain]].
| Micro      = nests of cells (spindle, epithelioid or spindle/epithelioid) - in both dermis and epidermis - nests are vertically arranged ("hanging bananas"), +/-hyperkeratosis, +/-hypergranulosis, +/-[[acanthosis]] (thick stratum spinosum), Kamino bodies - dense eosinophilic bodies (rare in melanoma)
| Subtypes  =
| LMDDx      = [[malignant melanoma]], [[pigmented spindle cell nevus of Reed]]
| Stains    = HMB-45 -ve deep aspect, Ki-67 usu. low
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[skin]] - typically face or extremity
| Assdx      =
| Syndromes  =
| Clinicalhx = children and adolescents
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = [[melanoma]], other [[melanocytic lesions]]
}}
'''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==
==General==

Revision as of 01:23, 6 December 2013

Spitz nevus
Diagnosis in short

Spitz nevus. H&E stain.

LM nests of cells (spindle, epithelioid or spindle/epithelioid) - in both dermis and epidermis - nests are vertically arranged ("hanging bananas"), +/-hyperkeratosis, +/-hypergranulosis, +/-acanthosis (thick stratum spinosum), Kamino bodies - dense eosinophilic bodies (rare in melanoma)
LM DDx malignant melanoma, pigmented spindle cell nevus of Reed
Stains HMB-45 -ve deep aspect, Ki-67 usu. low
Site skin - typically face or extremity

Clinical history children and adolescents
Prevalence uncommon
Prognosis benign
Clin. DDx melanoma, other melanocytic lesions

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

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.