Spitz nevus

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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]
    • Kamino bodies are rare in melanoma.
    • Pathogenesis uncertain - probably represent aggregates of basement membrane material.[5]
      • The classic teachng is Kamino bodies are apoptotic cells; however, this is disputed by evidence.[6]

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. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2797485/.
  5. Skelton, HG.; Miller, ML.; Lupton, GP.; Smith, KJ. (Dec 1998). "Eosinophilic globules in spindle cell and epithelioid cell nevi: composition and possible origin.". Am J Dermatopathol 20 (6): 547-50. PMID 9855349.
  6. Wesselmann, U.; Becker, LR.; Bröcker, EB.; LeBoit, PE.; Bastian, BC. (Dec 1998). "Eosinophilic globules in spitz nevi: no evidence for apoptosis.". Am J Dermatopathol 20 (6): 551-4. PMID 9855350.
  7. Jakubovic, H. 16 July 2010.