Spitz nevus on the palm with crista transverse dots/dotted lines revealed by dermoscopic examination

Abstract

Dear Editor, Spitz nevus is a variant of melanocytic nevus characterized by spindle and/or epithelioid tumor cells. It usually develops on the face or neck; only three cases of Spitz nevus on the palm have been reported. 1-3 Herein, we describe a case of Spitz nevus on the palm, in which crista dots/dotted lines were observed by dermoscopic examination.A 16-year-old male presented to our hospital for evaluation of an asymptomatic pigmented lesion, located on the right palm ( Fig. 1a). He had noticed a pigmented spot 1 year previously but received no treatment. Afterwards, the spot enlarged gradually and comprised a striated pigmented lesion that measured 1 mm 9 5 mm. By dermoscopic examination, we detected non-typical parallel furrow pattern (PFP) with crista transverse dots/dotted lines and three subtle spike projections adjacent to the cristae cutis ( Fig. 1b). We resected the lesion, and histopathological examination revealed several small nests in the lower half of the epidermis, composed of large epithelioid-shaped melanocytes. Artifactual clefts were observed between tumor nests and epidermal cells ( Fig. 1c,d). No melanocytes were seen in the dermis. Based on these findings, we diagnosed the lesion as junctional Spitz nevus.Spitz nevus was first described by Sophie Spitz in 1948. It is also known as spindle and epithelioid cell nevus. It usually develops on the face or neck in the first two decades and consists of a dome-shaped; hairless; and red, skin-colored, brown or black nodule. 4 Because our case indicated a brown-colored striated lesion and melanin pigment in histopathological examination, a more precise diagnosis may be Reed nevus, a variant of Spitz nevus. Some cases of Spitz nevus are difficult to differentiate from malignant melanoma based on clinical and/or histopathological manifestation. Dermoscopic examination is useful in differentiating Spitz nevus and malignant melanoma. 2 Dermoscopic patterns most commonly associated with Spitz nevus are starburst; negative network; and thickened dark reticular, globular and homogenous patterns. 5 However, we could not detect these typical patterns; rather, we observed only PFP with crista transverse dots/dotted lines and subtle projections. In addition, dermoscopy showed dots/dotted lines on both furrows and ridges, which would correlate with nests of melanin-laden melanocytes on both cristae profundae limitans and intermedia.Dermoscopic examination was performed in two previous cases of Spitz nevus on the palm. Yasuma et al. described a 9year-old girl with a pigmented macule of 1-year duration on her palm. Dermoscopic examination revealed blackish diffuse pigmentation with starburst and PFP. 2 Histopathological examination revealed compound Spitz nevus. Vaccaro et al. described a 28-year-old woman with a 2-month history of a rapidly growing Spitz nevus on her palm. 3 PFP, large radial projections and a globular pattern were observed by dermoscopic examination. Histopathologically, this case was junctional Spitz nevus, similar to ours. In our case, PFP ...

Acral pigmented Spitz nevus in a child with transepidermal migration of melanocytes: Dermoscopic and reflectance confocal microscopic features

“…Given the challenge of distinguishing benign from malignant lesions on clinical grounds, noninvasive imaging modalities to improve diagnostic accuracy and avoid unnecessary surgical procedures have been studied. Dermoscopy has been used to characterize acral Spitz nevi . One such case on the finger of a 3‐year‐old boy was found to demonstrate changes in dermoscopy over a 6‐month period .…”

“…This case suggested that different morphologic expressions over time on dermoscopy may correspond to varying evolutionary phases. In addition to the traditionally described dermoscopic patterns of starburst and globular arrangements, Nakagawa and colleagues described a novel pattern of crista transverse dots on dermoscopy in a palmar Spitz nevus on an adolescent boy …”

“…The acral presentation of pigmented Spitz nevi is rarely described in the literature . Dermoscopy has proven to be of significant utility as a diagnostic tool in the evaluation of these lesions . Reflectance confocal microscopy (RCM) is a noninvasive imaging modality with a maximum imaging depth of up to 200 μm.…”

“…5 Dermoscopy has proven to be of significant utility as a diagnostic tool in the evaluation of these lesions. [5][6][7] Reflectance confocal microscopy (RCM) is a noninvasive imaging modality with a maximum imaging depth of up to 200 lm. It has been found to aid in the diagnosis of clinically equivocal lesions, including differentiation of acral lentiginous melanoma (ALM) from acral nevi, 8 but skin lesions on the palms and soles are rarely investigated using RCM because of the thickness of the stratum corneum, which makes visualization of deeper structures difficult.…”

Acral reed nevus with parallel ridge pattern: an exception to the rule of malignancy

“… 2 However, a characteristic pattern upon dermoscopic examination of SN localized on the glabrous skin has not been described. 2 , 3 A review of the literature revealed only nine cases of acral SN and its variants with the dermoscopic examination. 4 A parallel furrow pattern with peripheral dots, streaks, and projections and a starburst pattern has been reported in four and three cases, respectively.…”