Nevo de Spitz: relato de caso e dermatoscopia

Abstract

Resumo: O nevo de Spitz é uma lesão melanocítica benigna com características clínicas e histopatológicas semelhantes às do melanoma. Foi descrito em 1948, mas até hoje, ainda, existe grande controvérsia no seu diagnóstico e conduta. A utilização da dermatoscopia pode aumentar a sua acurácia diagnóstica. As características dermatoscópicas do nevo de Spitz incluem um padrão estelar (starburst), que é o mais frequente, seguido do padrão globular e do padrão atípico. O diagnóstico deve ser confirmado por exame histopatológico, principalmente, nos casos atípicos. Palavras-chave: Dermatoscopia; Melanoma; Nevo de células epitelioides e fusiformes Abstract: The Spitz nevus is a benign melanocytic lesion with clinical and histopathological features similar to those of melanoma. It was first described in 1948 but great controversy still remains today with respect to its diagnosis and management. The use of dermoscopy may increase diagnostic accuracy. In Spitz nevus, the most common dermoscopic finding is a starburst-like pattern, followed by globular and atypical patterns. Diagnosis must be confirmed by histopathology, particularly in atypical cases.

Spitz nevus and Reed nevus

“…It is also called dermatoscopy, surface microscopy and epiluminescence microscopy. 7,18,27 Three main dermoscopic patterns have been recognized: 1,8,14 1 -Starburst pattern, observed in 53% of the cases. This is a pattern with prominent central pigmentation, diffuse, bluish-gray or black, also called black lamella, corresponding to the region of greatest parakeratosis, and streaks distributed around the lesion that correlate to areas of cell nest compression observed in histopathology.…”

“…[1][2][3][4][5][6][7][8] Later, Arthur C. Allen (1953) included juvenile melanoma in the category of benign melanocytic lesions due to its benign biological behavior, although it presented a cytoarchitecture that was similar to that of melanoma. [6][7][8][9][10] These two authors classified Spitz nevus as a distinct type of nevus.…”

“…6,7,13 In adults, it usually presents as a brown or black papule or plaque located in the trunk or lower limb, being pigmented in 72% of the cases and infrequent in the palmoplantar region. 1,6,20 Hypopigmented lesions can be mistaken by amelanotic melanoma and its polypoid variant shows similarities with polypoid melanoma. 6,10 Caucasians seem to be the most affected race, with a higher but discreet incidence in women, perhaps due to the fact that they seek more medical care for cosmetic reasons.…”

“…Therefore, it is believed that the patterns are, in fact, steps in the evolution process of the same lesion and not distinct clinical and pathological entities. 1,6,7,14,18,20,24 This may explain the rare presentation of the disease in the elderly, as these nevi may undergo a process of gradual involution over the years. 24 This is also consistent with observations of a previous study in which the cell maturity observed at the base of the lesion was more often seen in adults than in children, suggesting a development and stabilization process of these nevi.…”

“…Spitzoid melanoma Spitz nevi, in their majority (approximately 66%) are compound 8 , 5-10% junctional and 12-20% dermal. 1,31 The architectural aspect of the lesion includes symmetry, size smaller than 1.0 cm, cell maturation, shallow depth and little or no pagetoid dissemination (epidermotropism), as shown in Figure 7.…”