Verrucous Spitz Nevus in a Japanese Female

Abstract

A 23-year-old female presented with a reddish-brown dome-shaped hyperkeratotic nodule of 11 × 10 mm on the left lower leg. Dermoscopic examination demonstrated a prominent whitish scaly area with ring-like appearance, pinkish-white structureless areas, a few milia-like cysts, dotted and glomerular vessels, and light brown globules. The lesion was completely excised under the diagnosis of verruca vulgaris or dermatofibroma. Histopathological examination revealed a well-circumscribed symmetric lesion with hyperkeratosis, acanthosis, and pseudohorn cysts. The lesion was composed of spindle-shaped and epithelioid melanocytes with large cytoplasm arranged in confluent nests surrounded by stromal fibrosis. Mitotic figures and Kamino bodies were absent. Moderate proliferation of capillaries was found in the papillary dermis. Immunohistochemical staining with melan-A or S-100 was positive for tumor cells, but the staining with HMB-45 was negative. Melan-A staining was weaker in the deeply situated cells than in the superficial ones, which is known as stratification. Finally, we made a diagnosis of verrucous Spitz nevus based on these findings. We should have been aware of the entity of verrucous Spitz nevus as a variant of Spitz nevus and its dermoscopic features in order to reach a correct diagnosis before excision.

The stars within the melanocytic garden: unusual variants of Spitz naevi

“…The desmoplastic, angiomatoid and verrucous variants are considered uncommon presentations of Spitz naevi. These variants have been described mainly in their histopathological aspects, while clinical and dermoscopic presentation have been reported only rarely . In our series of 13 unusual Spitz naevi, only the angiomatoid subtype displayed features similar to that of classical Spitz naevus, namely presenting as amelanotic plaques that showed dotted vessels on dermoscopy.…”

“…However, Spitz naevi may present a wide spectrum of morphologies. Histopathologically, many variants, including desmoplastic, angiomatoid, verrucous/polypoid, plexiform, pagetoid, halo, myxoid, granulomatous and tubular Spitz naevi have been described . Clinical and dermoscopic features of these unusual variants of Spitz naevi have been reported only rarely.…”

“…Clinical and dermoscopic features of one verrucous Spitz naevus have been described recently. In this case the lesion showed clinical and dermoscopic features of a verruca vulgaris.…”

“…These variants have been described mainly in their histopathological aspects, while clinical and dermoscopic presentation have been reported only rarely. [17][18][19][20][21][22][23][24][25] In our series of 13 unusual Spitz naevi, only the angiomatoid subtype displayed features similar to that of classical Spitz naevus, namely presenting as amelanotic plaques that showed dotted vessels on dermoscopy. Although these dermoscopic features allowed for a correct clinical diagnosis of a melanocytic tumour, a reliable differential diagnosis between Spitz naevus and amelanotic melanoma was not possible.…”

“…Histopathologically, many variants, including desmoplastic, angiomatoid, verrucous/polypoid, plexiform, pagetoid, halo, myxoid, granulomatous and tubular Spitz naevi have been described. 12,[14][15][16][17][18][19][20][21][22][23][24][25] Clinical and dermoscopic features of these unusual variants of Spitz naevi have been reported only rarely. The aim of this case series is to describe clinical, dermoscopic and histopathological features of uncommon morphological variants of Spitz naevi, in order to raise awareness among clinicians about their peculiar patterns of presentation.…”