Polypoid Spitz naevus: the benign counterpart of polypoid malignant melanoma

Spitz nevus is an infrequent, usually acquired melanocytic nevus composed of epithelioid and/or spindle melanocytes that can occasionally be confused with melanoma. Currently, there are no immunohistochemical markers or molecular biology techniques that can be used to make an entirely safe diagnosis of Spitz nevus or melanoma in problematic cases. A retrospective study has been carried out that included all the cases diagnosed as Spitz nevus from our files. Follow-up information of the patients was unavailable. Three hundred forty-nine cases of unequivocal Spitz nevi were included, and their clinical and histopathological parameters were reviewed. One hundred and forty patients (40%) were 15 years old or younger, with a male to female ratio of 1:1. In patients older than 15 years, there was an evident predominance of women, with a male to female ratio of around 1:3. Spitz nevus was most commonly located on the lower extremities, followed by the trunk in both children and adults. Despite the fact that the head and neck were the third most common location in children, it was a much more frequent location in children than in adults. The constitution by epithelioid and/or spindled cells was the only histopathological finding present in 100% of cases. The other pathological findings studied were, from more to less frequent: maturation (72%), inflammatory infiltrate (70%), epidermal hyperplasia (66%), melanin (50%), telangiectasias (40%), Kamino bodies (34%), desmoplastic stroma (26%), mitosis (23%), pagetoid extension (13%), and hyalinization of the stroma (8%). Hyalinization was the only histopathological parameter that was statistically more frequent in adults than in children.

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“…23 Despite this fact, we found telangiectasias in 40% of our cases, but only in 4% of them were the dilated blood vessels abundant.…”

Section: Discussionmentioning

confidence: 60%

Spitz Nevus: A Clinicopathological Study of 349 Cases

Requena

Requena²,

Kutzner³

et al. 2009

The American Journal of Dermatopathology

158

143

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“…The histomorphology resembles to some extent a malignant melanoma, but the clinical course is benign. In many cases, a halo phenomenon has also been observed surrounding the lesion 1 6. SN is described as particularly common in young adults and children, but a recent published study showed that approximately two-thirds of patients with SN were over 20 years of age 7.…”

Section: Introductionmentioning

confidence: 99%

Human polyomavirus DNA detection in keratoacanthoma and Spitz naevus: no evidence for a causal role

2016

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Keratoacanthomas (KA) and Spitz naevus (SN) are both lesions with unknown aetiology; therefore, the possibility of a viral involvement, more specifically the involvement of human polyomaviruses (HPyV), was investigated. In total, 22 cases of KA and 25 cases of SN were tested for the presence of HPyVs. DNA was extracted and amplified by multiplex PCR and thereafter tested with a multiplex bead-based assay for HPyVs (BKPyV, JCPyV, KIPyV, WUPyV, MCPyV, TSPyV, HPyV6, 7 and 9) and two primate viruses (SV40 and LPyV). HPyV DNA was found in 20 of the 47 lesions. There was no significant difference in HPyV DNA detection frequency between patients diagnosed with KA and patients diagnosed with SN, nor any over-representation of a specific HPyV type in any of the two patient categories. In conclusion, evidence for a specific aetiological role of any of the above tested HPyVs in either KA or SN was not disclosed.

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“…Differential diagnosis from polypoid Spitz nevus is one of the main concerns regarding pathologic examination because the latter, clinically, reproduces the silhouette of melanoma; also, histologically, it is equipped with cells showing prominent atypia with big nuclei and expansive nodules. 8 Pathologic distinctive features are shown in Table 2.…”

Section: Y5mentioning

confidence: 99%

“…7,8 The typical polypoid melanoma is 2 cm in diameter, Clark level IV, ulcerated, and pigmented with high rate metastasis and poor prognosis. 3,4 Clinically differential diagnosis includes neurofibroma, seborrheic keratosis, pyogenic granuloma, squamous cell carcinoma, basal cell carcinoma, and hemangioma.…”

Section: Y5mentioning

confidence: 99%

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Head and Neck Polypoid Melanoma

Dini¹,

Quercioli²,

Caldarella³

et al. 2012

Journal of Craniofacial Surgery

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Polypoid melanoma represents a rare clinical variant of nodular melanoma skin cancer in which the tumor is connected to the skin by a pedicle, characterized by exophytic growth, ulceration, and young age at onset (20Y39 years) with a special predilection for the back and with a survival rate at 5 years ranging from 32% to 42% as compared with 57% 5-year survival for nodular subtype and 77% for the superficial subtype. We present a case of a deeply pigmented polypoid melanoma arising on the face of a 77-year-old man. We performed a literature review to clarify its surgical management and prognosis.Key Words: Melanoma, polypoid melanoma, pedunculated melanoma, sentinel node biopsy, review P olypoid melanoma, first classified in 1958 by Vogler and coworkers, is a type of melanoma characterized by exophytic thickness, usual ulceration, and young age at onset (20Y39 years) with a special predilection for the back and with a survival rate at 5 years ranging from 32% to 42% as compared with 57% 5-year survival for nodular subtype and 77% for the superficial subtype. 1Y4 As previously asserted, it should be specified that the term ''pedunculated'' is different from ''polypoid''; according to McGovern et al, 2 polypoid melanoma is classified as pedunculated when the lesion is entirely above the skin surface and connected to the skin by a stalk. 5Y7 The main concern regards the differentiation from the sessile polypoid melanoma that lies at least half above the skin surface.7 It is common on mucosae including the upper respiratory tract, esophagus, vagina, and rectum and behaves as a level IV or V tumor with a very rapid progression and poor prognosis.1Y3 It has been postulated that the poor prognosis would be related to the high risk of vascular embolism under the lesion. 7 The incidence reported in the medical literature varies from 2% to 43%.2 Clinically, it shows a rapid growth, taking only few weeks to became huge. Morphologically, it shows marked cytologic atypia, cellular and nuclear pleomorphism, organization in large sheets of cells, and high mitotic rate. 7,8 CLINICAL REPORTWe report a case of a polypoid melanoma arising on the face of a 77-year-old man with characteristic features and clinical course. The lesion developed in few weeks and was characterized by rapid

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Polypoid Spitz naevus: the benign counterpart of polypoid malignant melanoma

Cited by 25 publications

References 14 publications

Spitz Nevus: A Clinicopathological Study of 349 Cases

Spitz Nevus: A Clinicopathological Study of 349 Cases

Human polyomavirus DNA detection in keratoacanthoma and Spitz naevus: no evidence for a causal role

Head and Neck Polypoid Melanoma

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