Eruptive disseminated Spitz nevi - Case report,

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AnBrasDermatol.2020;95(1):71---74

Anais

Brasileiros

de

Dermatologia

www.anaisdedermatologia.org.br

CASE

REPORT

Eruptive

disseminated

Spitz

nevi

---

Case

report

夽,夽夽

Pablo

Vargas

a_,_∗

_,

_Rodrigo

_Cárdenas

b

_,

_Roberto

_Cullen

a

_,

_Andrés

_Figueroa

c

a_Department_of_Dermatology,_Faculty_of_Medicine,_University_of_Chile,_Santiago,_Chile

b_Clínica_Alemana_de_Valdivia,_Valdivia,_Chile

c_Dermatology_Service,_University_of_Chile_Clinical_Hospital,_University_of_Chile,_Santiago,_Chile

Received26June2018;accepted14January2019 Availableonline12December2019

KEYWORDS

Epithelioidand spindlecell;

Immunohistochemistry; Neviandmelanomas; Nevus

Abstract Spitznevus isa benignmelanocytic lesion,which presentsin severalways: soli-tary,agminated,ordisseminated.Thedisseminatedvariantisuncommon;itmayhavearapid evolution(theeruptiveform)andbedifficulttomanage.Thisreportpresentsthecaseofa 24-year-old patientwithmultiplepapulesonhislimbs,which hadappearedfour years pre-viously.Onphysicalexamination,120pinkandskin-coloredpapuleswereseen,whichunder dermoscopywere observedtobehomogeneous,pinkvascularlesions. Histopathologicstudy revealedepithelioidcellsarrangedingroupsorsinglyinthedermisanddermo-epidermal junc-tion.TheywereHMB-45positiveinthesuperficialdermis,andKi-67<1%.Giventhesefindings, adiagnosisoferuptivedisseminatedSpitzneviwasmade.

Introduction

Spitznevusis abenignmelanocytic lesion,whichpresents inawidevarietyofclinicalandhistopathologicexpressions. Its biological behavior over time tends to be uncertain.

夽 _How_to_cite_this_article:_Vargas_P,_Cárdenas_R,_Cullen_R,_Figueroa

A.EruptivedisseminatedSpitznevi---Casereport.AnBrasDermatol.

2020;95:71---4.

夽夽_Study_conducted_at_the_Department_of_Dermatology,_Faculty_of

Medicine,UniversityofChile,Santiago,Chile.

∗_{Corresponding}_author.

E-mail:[email protected](P.Vargas).

It is classiﬁed into solitary, agminated, and disseminated forms.DisseminatedSpitzneviis ararepresentation that may have a rapid (eruptive) evolution, or may develop over a prolonged period of time, several years (non-eruptive).1,2

Thisreportpresentsthe caseof aChileanpatientwith eruptiveSpitznevi,giventheunusualnatureofthisclinical variantandthefewreportsintheliterature.

Case

report

A 24-year-old male patient, with no signiﬁcant morbid history. He was referred to this hospital because of the appearance,fouryearspreviously,ofmultipleraisedlesions https://doi.org/10.1016/j.abd.2019.01.010

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72 VargasPetal.

Figure1 (AandB)Pinkandskin-coloredpapules,withawarty appearanceandasessilebase.

onthe arms,elbows,thighs, andknees.They hadarapid progressiveevolutioninsizeandnumber,withnomention of pain, pruritus, hemorrhage, or other problems. Some lesions, mainly on the arms, had spontaneously resolved after ten to12 months. On physical examination approx-imately 120 pink and skin-colored papules were seen, with a warty appearance and a sessile base. Some were pedunculated. They were from 2 to 9mm in diameter, andwere symmetrically distributed onthe knees, thighs, elbows, and arms (Fig. 1). Dermoscopy showed homoge-neouspinkvascularlesions,withsmallscalesonthesurface (Fig.2).Excisionalbiopsywasperformedonthreelesions, whichrevealedessentiallysimilarfeatures:asymmetrical andwell-circumscribedcompoundmelanocyticproliferation composed of epithelioid cells with abundant eosinophilic cytoplasm arrangedin groups or singly in the dermis and dermo-epidermaljunction.Therewerevariableamountsof melanin pigment, hyalinization, and vascularization. Nei-thersigniﬁcantcytologicalatypianormitosiswereobserved (Fig.3).Immunohistochemicalstudy showedSOX10 witha

Figure 2 Dermoscopy: homogeneous pink vascular lesion, withsmallscalesonthesurface.

nuclearstainingpattern inmelanocytes, S100proteinwas positive,andtheKi-67labelingindexwas<1%(Fig.4).Given these ﬁndings, a diagnosis of eruptive disseminated Spitz neviwasmade,andthepatientagreedtothesurgical exci-sionofthemainlesionsundergeneralanesthesiaandstrict follow-up.

Discussion

Eruptive disseminatedSpitzneviwasdescribedin 1974as juvenileeruptivemelanoma,byWallaceetal.3_It_is_a_rare pathology withonly 27 reports in theliterature todate.4 The present case correlates with those described, given that the average age for the onset of the clinical

symp-Figure3 (AandB)Asymmetricalandwell-circumscribedcompoundmelanocyticproliferation,arrangedinepitheloidcellnests (A.Hematoxylin&eosin,×40,B.Hematoxylin&eosin,×100).(C)Epithelioidmelanocyteswithabundanteosinophiliccytoplasm, vesicularnucleus,andnucleolus(C.Hematoxylin&eosin,_×400).

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EruptivedisseminatedSpitznevi 73

Figure4 Immunohistochemicalstudy.(A)SOX10withanuclearstainingpatterninmelanocytes.(B)S100proteinwaspositive. (C)S100proteinwaspositive.

tomsis21years.Therearereportsfromnewbornpatientsto 35-year-old adults. The majority are women and in most cases there are no trigger factors. Isolated associations havebeendescribedwithchemotherapy,intravenousdrugs, surgery,exposuretothesun,andpregnancy.5,6_The_lesions usually appear on the trunk and the proximal limbs. There have been four cases of spontaneous partial res-olution, a condition observed in the present patient. It is of utmost importance to perform differential diagno-sis, todistinguish between this and metastatic malignant melanoma,alsotakingintoaccountmultiplejuvenile xan-thogranuloma, urticaria pigmentosa, and dysplastic nevi syndrome.

In adults, a solitary Spitz nevus is usually treated by surgical removal,after clinical diagnosis, givenits uncer-tainbiological behavior. Inpractice,this is difﬁcult todo inthe eruptive variant,considering thenumber oflesions seen. Various therapeutic options have been tried, such as electrocoagulation,7 _liquid _nitrogen,8 _and _imiquimod,9 without success. Although malignization has not been reported,thefewcasesreportedanditserraticevolution requires offering the patient several therapeutic options, fromconservativemanagementwithclinicalfollow-upand regular dermoscopy, to active management with topi-cal or surgical therapy, as is the case with the present patient.10

Financial

support

Nonedeclared.

Authors’

contribution

PabloVargas:Approvaloftheﬁnalversionofthemanuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpretingthedata;effectiveparticipationinresearch ori-entation;criticalreviewoftheliterature;criticalreviewof themanuscript.

Rodrigo Cárdenas: Approval of the ﬁnal version of the manuscript;obtaining,analyzing,andinterpretingthedata; critical review of the literature; critical review of the manuscript.

Roberto Cullen: Approval of the ﬁnal version of the manuscript;obtaining,analyzing,andinterpretingthedata; criticalreviewoftheliterature.

Andrés Figueroa: Approval of the ﬁnal version of the manuscript;obtaining,analyzing,andinterpretingthedata; intellectualparticipationinpropaedeuticand/or therapeu-tic conduct of the cases studied; critical review of the manuscript.

Conﬂicts

of

interest

Nonedeclared.

References

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