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Sequential dermoscopic evolution of pigmented Spitz nevus in childhood

2003; Elsevier BV; Volume: 49; Issue: 3 Linguagem: Inglês

10.1067/s0190-9622(03)00778-3

1097-6787

Domenico Piccolo, Angela Ferrari, Ketty Peris,

Nail Diseases and Treatments

To the Editor: We read with great interest the article of Pizzichetta et al1Pizzichetta M.A. Argenziano G. Grandi G. De Giacomi C. Trevisan G. Soyer H.P. Morphologic changes of a pigmented Spitz nevus assessed by dermoscopy.J Am Acad Dermatol. 2002; 47: 137-139Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar in the July 2002 issue of the journal. We report 2 additional cases of pigmented Spitz nevus in childhood, characterized by remarkable dermoscopic changes over an 18-month period. A 3-year-old girl was examined for a 6-mm, dark-brown papule located on her right leg, which had appeared 1 year earlier. Dermoscopic examination revealed typical features of pigmented Spitz nevus consisting of a central prominent gray-blue pigmentation and a rim of peripheral large blue-black globules2Argenziano G. Soyer H.P. De Giorgi V. Piccolo D. Carli P. Delfino M. et al.Reed and Spitz nevi. In: Interactive atlas of dermoscopy. Dermoscopy: a tutorial (book) and CD-ROM. Edra Medical Publishing and New Media, Milan (Italy)2000Google Scholar, 3Peris K. Ferrari A. Argenziano G. Soyer H.P. Chimenti S. Dermoscopic classification of Spitz/Reed nevi.Clin Dermatol. 2002; 20: 259-262Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar (Fig 1 A, ). Three months later, the lesion enlarged, measuring 7.3 mm at its largest diameter; dermoscopy showed a starburst pattern with radial streaks regularly distributed over the entire lesion and a central prominent gray-blue pigmentation (Fig 1, B). One year after the first observation, the lesion measured 9 mm and a variation of the starburst pattern with elongated streaks and a central reticular depigmentation (negative pigment network) were observed (Fig 1, C). Notably, after a follow-up period of 6 months, further dermoscopic changes included the disappearance of the starburst pattern and the presence of a reticular pattern with a diffuse homogeneous blue-brown pigmentation in the center of the lesion (Fig 1, D). The second patient was a 1-year-old boy with a 4-mm, dark-brown to black papule on the right leg that had appeared 6 months earlier. Dermoscopic analysis supported the clinical diagnosis of pigmented Spitz nevus showing a central blue-brown pigmentation and peripheral brown to black globules (Fig 2,, A). Six months later, the lesion measured 7 mm and showed a stereotypical starburst pattern with a central, diffuse blue-brown pigmentation and peripheral streaks (Fig 2, B). No clinical or dermoscopic changes were observed for the following 6 months (Fig 2, C). Eighteen months after the first observation, the lesion measured 9 mm, and disappearance of the starburst pattern and the presence of a homogeneous central blue-brown pigmentation (Fig 2, D) were detected by dermoscopic analysis. No other changes were detected in either patient during the following 6 months; they are currently being followed up. Our cases, compared with that reported by Pizzichetta et al,1Pizzichetta M.A. Argenziano G. Grandi G. De Giacomi C. Trevisan G. Soyer H.P. Morphologic changes of a pigmented Spitz nevus assessed by dermoscopy.J Am Acad Dermatol. 2002; 47: 137-139Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar show a similar clinical growth and dermoscopic sequential evolution from a globular to a starburst pattern. However, a distinctive dermoscopic change, characterized by the disappearance of streaks at the periphery of the lesion and the presence of a central homogeneous pigmentation, was detected in our patients 1 year after the initial examination. On the basis of our results, the central homogeneous pigmentation might reflect a further evolutionary phase of pigmented Spitz nevus in childhood. In conclusion, in line with previous reports,1Pizzichetta M.A. Argenziano G. Grandi G. De Giacomi C. Trevisan G. Soyer H.P. Morphologic changes of a pigmented Spitz nevus assessed by dermoscopy.J Am Acad Dermatol. 2002; 47: 137-139Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar, 4Kreusch J. Rassner G. Auflichtmikroskopie pigmentierter Haut-tumoren. Thieme, Stuttgart-New York1991Google Scholar we support the hypothesis that the globular and starburst pattern, and the homogeneous pigmentation observed in our patients, might represent the morphologic counterpart of the lesion's biologic evolution rather than the expression of different clinicopathologic entities.