Pagetoid spitz nevus

Spitz nevus is a clinico-pathologic entity that can cause diagnostic concern, particularly in adults. Many studies have been performed to establish reliable histologic criteria, in the attempt to differentiate this lesion from melanoma. A series of 247 Spitz nevi, 6 of which were formerly classified as melanomas, were reviewed for clinical and histopathological parameters. Patients older than 20 comprised 66% of cases, with a predominance of women. The lower extremity was more affected in females of any age, whereas the trunk was more frequently involved in men over 40...

BACKGROUND: In vivo confocal microscopy enables skin visualization with a quasihistopathologic resolution. OBJECTIVE: We sought to describe confocal features in melanocytic lesions and to evaluate their diagnostic significance for melanoma (MM) identification. METHODS: Thirty seven MMs, 49 acquired nevi, and 16 Spitz/Reed nevi, presenting equivocal clinicodermoscopic aspects were investigated by confocal microscopy. RESULTS: MMs and nevi significantly differed for some aspects...

Numerous variants of melanocytic naevi have been described. Their main pathological significance lies in their distinction from melanoma, as well as being precursors and risk markers for melanoma. Various degrees of atypia such as cytological atypia, architectural disorder and pagetoid spread (pagetoid melanocytosis) may be present in naevi and need to be recognised as appropriate for the subtype. As well as the distinction from melanoma, naevi must be differentiated from atypical lesions, such as atypical Spitz tumours, which do not fulfil all the criteria of melanoma, may be benign or malignant and have been called 'melanocytic tumours of unknown malignant potential'...

The histological appearance of benign melanocytic naevi and malignant melanomas can be variable, causing in a significant number of cases severe differential diagnostic problems. The early, thin (less than 1 mm) melanomas have to be differentiated from naevi containing dominant junctional or lentiginous component or pagetoid melanocytosis and from some epithelial tumours, while in cases of thick lesion the diagnosis of thick melanoma, Spitz naevus, deep penetrating naevus or cellular blue naevus should be considered for example...

This report describes 22 Spitz nevi that seemed to have been clinically removed but persisted and clinically recurred at the biopsy site. These were evaluated in terms of histopathology, immunohistochemistry, and molecular pathology using comparative genomic hybridization (CGH) and fluorescent in situ hybridization. One of these 22 lesions was originally reported as an atypical melanocytic proliferation with some features of a Spitz nevus and was included in the study set at an early stage but was later recognized as melanoma after metastasis to regional lymph nodes 3 years after the local recurrence...

Benign melanocytic naevi exhibit a wide spectrum of histological appearances. Some share significant clinical and histological features and are recognized as entities. Included among these are pagetoid/junctional Spitz naevus, pigmented spindle cell naevus, halo naevus, recurrent and traumatized naevus, ultraviolet (UV) irradiated naevus, naevus in infants, acral naevus, genital naevus and naevi from other specific anatomic locations. However, there still remains a diagnostic grey area of acquired predominantly junctional naevi with architectural and cytological atypia...

Pagetoid melanocytosis (PM) represents a more precise formulation of the histological phenomenon previously referred to as pagetoid scatter/spread. PM is defined as the upward discontinuous extension of melanocytes into the superficial epidermis. Three histological criteria are presented. PM is a frequent finding in malignant melanoma, occurring in approximately 76% of lesions. PM also occurs in a significant number of certain benign melanocytic lesions: Spitz nevi, nevi of palms and soles, pigmented spindle cell nevi, recurrent nevi, vulvar nevi, and nevi of infancy and childhood...

We describe two examples of malignant melanoma that present with clinical and histopathologic characteristics resembling the benign acquired dermal nevus and the spindle and epithelioid cell nevus (Spitz's nevus), respectively. Both lesions were present on the trunk of adult patients. The clinical impression in both cases was dermal nevus. Histopathologically, these lesions were fairly well circumscribed and symmetrical; they exhibited an expansile dermal proliferation of atypical nevomelanocytes in nests and fascicles with only minimal intraepidermal involvement...

Cutaneous malignant melanoma and its precursors were the general subjects of the National Institutes of Health Consensus Conference held in January 1992. Particular emphasis was placed on the diagnosis of early melanoma, especially melanoma in situ, and the controversies surrounding dysplastic nevi. Recent studies of unusual nevi often confused with melanoma, eg, deep-penetrating (plexiform) nevus, combined nevus, desmoplastic melanocytic nevus, and Spitz nevus in childhood, provided detailed histologic criteria for their discrimination from melanoma...

BACKGROUND: Acral nevi occasionally demonstrate pagetoid spread of melanocytes. This feature may be of considerable concern because it is commonly associated with melanoma. Other features of melanoma must be assessed to accurately classify these neoplasms as benign. OBJECTIVE: We examined acral melanocytic lesions, benign and malignant, to evaluate their features. METHODS: A retrospective analysis during 3 years was performed on 158 acral pigmented lesions diagnosed by the dermatopathology service...

Pagetoid melanocytosis (PM), the upward discontinuous extension of melanocytes into the superficial epidermis, although generally considered a histologic feature of malignancy, may be seen in certain benign melanocytic lesions. To formulate the histologic criteria for distinction between benign and malignant PM, we examined 218 melanocytic tumors, including melanomas, Spitz nevi, nevi of palms and soles, pigmented spindle cell nevi, recurrent nevi, vulvar nevi, nevi of infancy and early childhood, and ordinary acquired nevi...

A distinctive variant of melanocytic growth pattern is described, which appears to be related to Spitz nevus and is characterized by a mainly intraepidermal proliferation of large epithelioid melanocytes with a predominantly pagetoid distribution. This melanocytic lesion appears clinically as a small (< 0.4 cm) pigmented macule in young patients. Histologically, this lesion needs to be distinguished primarily from in situ or microinvasive malignant melanoma with pagetoid spread. Features favoring nevus over melanoma include small size, circumscription, symmetry, even distribution of cells, and lack of marked cytologic atypia...

Histological variance within premalignant melanocytic dysplasias and melanomas reflects the biological progression of neoplasia. In general, the more severe cytological atypia, the more advanced the stage of neoplasia, and the more likely true melanomatous transformation (vertical growth or level III invasion) will be present. Histological variance may be seen in disparity between the cytology of the premalignant precursor and the vertical growth component and in the expression of normally latent phenotypic options such as desmoplasia and neurotropism...

We reviewed 33 cases of Spitz naevus and 19 of malignant melanoma in patients aged 20 years or less who were evaluated at our institution from 1950 to 1975 and followed-up for up to 32 years. The histological findings were studied prior to review of clinical data. There were no malignant melanomas in patients less than 9 years old; almost half (15/33) of the Spitz naevi were in this age group. Among the 25 histological criteria evaluated in the 52 lesions, the most striking differences between malignant melanomas and Spitz naevi were a higher degree of pagetoid spread, cellular pleomorphism, nuclear hyperchromasia and mitotic activity in the malignant melanomas, and a more prominent spindle cell component in Spitz naevi...

The Spitz nevus (large spindle and/or epithelioid cell nevus) is a benign acquired melanocytic tumour found predominantly in children and adolescents. Depending on the architecture (junctional, compound, dermal) and cytology (predominance of spindle or epithelioid cells, or presence of both cell types) several variants have been distinguished. A histological feature occasionally leading to diagnostic difficulties is the involvement of the suprabasal epidermis. The present study details the occurrence of intraepidermal involvement (pagetoid spread, nesting of cells, trans-epidermal elimination) according to the age of the patients...

The histologic differential diagnosis of skin lesions characterized by large, atypical, clear cells in the epidermis includes Bowen's disease, Paget's disease (mammary and extramammary), malignant melanoma in situ (pagetoid precancerous melanosis), mycosis fungoides, Spitz nevus, and artifact. Our experience with these lesions indicates that these diseases can be differentiated immunohistologically by the standard peroxidase-antiperoxidase technique, using antibodies directed against keratin (KER), carcinoembryonic antigen (CEA), and S-100 protein (S-100)...

We report 22 cases of pigmented spindle cell naevus (PSCN). The usual appearance of these naevi is that of a heavily pigmented papule found mostly on the legs of young patients. Histologically, PSCN was characterized by symmetrical proliferation of spindle-shaped pigmented melanocytes grouped in large junctional nests. Pagetoid spread of single cells in the overlying epidermis was frequently found. In our opinion, PSCN is a distinctive benign acquired melanocytic naevus that in the past has been frequently misdiagnosed as atypical Spitz naevi or malignant melanoma...