Eruptive widespread Spitz nevi

Eruptive Disseminated Spitz Nevi: A Case Report and Review of the Literature

Spitz naevus (SN) are benign melanocytic lesions, which are classified into solitary, agminated, or disseminated forms. The most common form is solitary SN, typically occurring on the face and extremities of children. However, the disseminated SN is a rare presentation that can be either rapid eruptive or non-eruptive. The eruptive disseminated Spitz naevus (EDSN) often develops between the ages of 10 and 20 and affects nearly the whole-body surface, beginning in the trunk and/or extremities. Without prior reports from the population of Saudi Arabia, this eruptive SN has reportedly impacted native Alaskans (Americans), Koreans, Pakistanis, African Americans, and Hispanics. Eruptive disseminated SNs are rare, with only 27 cases having been reported in the literature. This article presents another case of EDSN.

Genetic Studies on a Case of Eruptive Disseminated Spitz Nevus and Review of Other 33 Cases

ABSTRACT

Eruptive disseminated Spitz nevus is an uncommon presentation of Spitz nevi. Only a few tens of cases have been published and only 6 of them have genetic studies. We present an additional case of a 29-year-old woman with dozens of Spitz nevi which had appeared since she was aged 10 years. The nevi were located on arms, inner thighs, legs, and buttocks. Nine of them were biopsied. Four presented severe atypia. Immunohistochemistry was performed on 5 of the biopsied specimens and was negative for PRAME, ROS-1, PDL-1, pan-TRK, and ALK. Molecular studies on the largest lesion demonstrated no NTRK1, NTRK2, or NTRK3 fusions. FISH study for PTEN showed no alteration in that same lesion. Next-generation sequencing was also negative for any detectable mutations in numerous genes analyzed. In conclusion, it seems reasonable to be cautious when evaluating atypia, even if severe, in cases of eruptive disseminated Spitz nevus.

Regressing Eruptive Disseminated Spitz Nevi

The eruptive disseminated form of Spitz nevi (EDSN) is the rarest variant, is cosmetically disabling, and has a poorly documented natural history. We report the case of a 4-year-old boy with more than 100 Spitz nevi that have significantly regressed 8 years after onset. There is no satisfactory treatment for EDSN. There have been no reports of supervening malignancy. Our case illustrates the possibility of regression of EDSN, corroborating long-term observation as a safe and acceptable management option.

Nodular lesions arising in a large congenital melanocytic naevus in a newborn with eruptive disseminated Spitz naevi

Congenital malignant melanoma within a pre-existing large congenital melanocytic naevus (CMN) is exceedingly rare. Its incidence is difficult to determine due to the small number of reported cases and because of problems associated with diagnosis. Some benign nodular proliferations (called proliferative nodules) arising in CMN, while rare, are significantly more common and can mimic malignant melanoma clinically or histologically. There are no reported cases of congenital melanoma or benign proliferative nodules in CMN in patients who also had eruptive disseminated Spitz naevi. We describe a girl who was noted to have a dark-brown plaque with several large erythematous nodules affecting the scalp at delivery, in addition to multiple erythematous dome-shaped papules that developed in a disseminated manner over several months, beginning at 10 days of age. It was difficult, not only clinically but also histologically, to determine the benign or malignant nature of all of these lesions. As primary cutaneous melanoma, atypical proliferative nodules in CMN, bland CMN or CMN with foci of increased cellularity and Spitz naevi show clear differences in the genetic aberration patterns, comparative genomic hybridization (CGH) could be a diagnostic help in ambiguous cases such as this. CGH performed on this patient showed multiple DNA copy number changes in the most atypical nodule, but such alterations could not be found in the remainder of the lesions. CGH showed differences between the nodular lesions that occurred in the CMN and helped us in supporting the diagnosis of this unique case of benign proliferative nodules and a possible congenital melanoma arising in a large CMN, associated with multiple widespread eruptive Spitz naevi.

Spitz nevi and other Spitzoid lesions part I. Background and diagnoses

Spitz nevi are melanocytic proliferations that are characterized by spindled and/or epithelioid nevomelanocytes. First interpreted as juvenile melanoma, these lesions were later characterized as benign and were observed to affect all age groups. Today, contrasting opinions persist regarding the fundamental benignancy versus malignancy within the spectrum of Spitz tumors. Beyond clinical outcome, this controversy has also been fueled by complex and sometimes convoluted classification schemes based on pathologic characteristics. More recently, immunophenotypic and molecular analyses have begun to clarify the etiologic nature of these tumors. Recent evidence suggests that histopathologic features that suggest more aggressiveness in Spitz tumors relate to mitoses and inflammation.

Absence of BRAF and HRAS mutations in eruptive Spitz naevi

BACKGROUND

Eruptive Spitz naevi have been reported rarely in the literature. In solitary Spitz naevi, BRAF and HRAS mutations, as well as increased copy numbers of chromosome 11p have been identified.

OBJECTIVES

To investigate the genetic changes underlying eruptive Spitz naevi.

METHODS

We report on a 16-year-old boy who developed multiple disseminated eruptive Spitz naevi within a few months. We analysed BRAF, HRAS, KRAS and NRAS genes in 39 naevi from this patient for hotspot mutations. Furthermore, comparative genomic hybridization analysis was performed in three lesions.

RESULTS

None of the Spitz naevi displayed a mutation in the analysed genes, and no chromosomal imbalances were observed. Conclusions  Our results indicate that the typical genetic alterations described in solitary Spitz naevi appear to be absent in eruptive Spitz naevi. Yet unknown alternative genetic alterations must account for this rare syndrome.

Eruptive disseminated Spitz naevi: dermatoscopic features

Eruptive disseminated Spitz naevi is a rarely reported condition. Although the dermatoscopic features of nondisseminated, solitary forms of Spitz naevi are well known, there are no reports describing the dermatoscopic features of eruptive disseminated variant. We report an additional case and describe the dermatoscopic features. Two patterns were observed. In all pink lesions, the vascular pattern was seen, composed of dotted, linear or comma-like vessels located at the centre of the meshes of the reticular depigmentation. In all brown lesions, we observed only the reticular pattern, which is quite interesting as the reticular pattern is a rare feature of Spitz naevi. This observation may be a special feature particularly seen in the eruptive disseminated variant. A superficial black network also accompanied reticular pattern in some lesions. In dichromatic lesions, both patterns were observed in different areas of the body.

Eruptive disseminated Spitz nevi

Eruptive disseminated Spitz nevi represent an extremely rare variant of Spitz nevi, with only 13 previous cases reported in the literature. We describe a unique case marked by the eruptive onset of numerous lesions posing considerable diagnostic difficulty.

Multiple Spitz naevi: a report of both variants with clinical and histopathological correlation

Spitz naevi are usually solitary lesions. Multiple Spitz naevi are extremely rare and reported as widespread (disseminated) or grouped (agminated). We report two cases of multiple Spitz naevi and review their aetiology and treatment.

Induction of eruptive benign melanocytic naevi by immune suppressive agents, including biologicals

BACKGROUND

Eruptive naevi have been described to potentially arise in immune compromised patients.

OBJECTIVES

We describe three patients with eruptive benign melanocytic naevi during a phase of immunosuppressive therapy. METHODS/DIAGNOSIS: Two patients with Crohn disease were treated with either azathioprine monotherapy or a combination of azathioprine and infliximab, when eruptive naevi arose particularly at the palms and soles. Our third patient with plaque psoriasis developed eruptive naevi during two episodes of treatment: during a course with the biological agent alefacept and during etanercept therapy.

CONCLUSIONS

We conclude that treatment with the recently available biological agents might be associated with the formation of eruptive naevi. Although positive evidence for the occurrence of malignant pigmented lesions is lacking, alertness to the development of eruptive melanocytic naevi during treatment with biological agents is indicated.

A case of multiple disseminated eruptive Spitz nevi

Spitz nevus is usually a solitary lesion. However, multiple Spitz nevi do arise and can be divided into two variants, agminated (grouped) or disseminated. We report an interesting case of multiple disseminated eruptive Spitz nevi with an unusual feature. The appearance of most of the nevi resembled that of melanocytic nevi, and clinically it was impossible to distinguish these multiple disseminated eruptive Spitz nevi from eruptive melanocytic one.

Adult onset of eruptive widespread Spitz's nevi

Cases of multiple Spitz's nevi are rare, usually occurring in the agminate form or even less commonly as widespread eruptive Spitz's nevi. Previously reported cases of widespread eruptive Spitz's nevi arose in persons age 23 or younger. We describe a Hispanic male patient with eruptive Spitz's nevi that presented at the age of 35 years.

Hyalinizing Spitz nevus

A seventeen-year-old Korean girl had a reddish-brown papular lesion on the nose. Histopathologically, it proved to be a "hyalinizing Spitz nevus" with the characteristic features of a discohesive growth pattern of nevus cells and hyalinized stroma. Immunohistochemical stains showed positive reactivity of nevus cells with S-100 protein and Vimentin and negative stainings with HMB45, CD68, CEA and low molecular weight cytokeratin. Hyalinizing Spitz nevus may represent a variant in the spectrum of Spitz nevus.

Multiple widespread eruptive Spitz naevi

A 19-year-old man presented with a widespread eruption of several hundred Sptiz naevi. He is still developing new lesions, 4 years after the problem began. No treatment to date has been satisfactory. The literature on prognosis and treatment of this condition is reviewed.

Widespread eruptive dermal and atypical melanocytic nevi in association with chronic myelocytic leukemia: case report and review of the literature

Eruptive nevi have been associated with local skin trauma and immunosuppression, and atypical eruptive nevi preceding melanoma have been reported in immunocompromised transplant patients. We describe a 25-year-old man with widespread eruptive atypical and dermal melanocytic nevi in association with chronic myelocytic leukemia. Our patient's disease differs from earlier reports of eruptive nevi because his nevi appeared before induction chemotherapy. Eruptive nevi may have been a prodrome to leukemia in this patient. His nevi were histologically similar to eruptive atypical nevi observed in AIDS patients and may imply a link between systemic immunosuppression and melanocyte proliferation. We suggest that patients in whom eruptive nevi develop in association with immunosuppression should be carefully observed for the development of melanoma skin cancer.

Agminate Spitz naevi occurring in an adult after the excision of a solitary Spitz naevus--report of a case and review of the literature

We describe a 21-year-old female who presented with four agminate Spitz naevi close to the scar from a previously excised solitary Spitz naevus, and review the literature since 1987 on widespread and agminate Spitz naevi. Spitz naevi usually present as solitary firm red or brown papular lesions. Agminate Spitz naevi are unusual and they have been reported mainly in children. It is uncommon for Spitz naevi to recur after surgery and far more unusual for a recurrence to occur in an agminate form. Such lesions may mimic multiple satellite and in-transit metastases which can occur in malignant melanoma, and close follow up of any new lesions occurring in this case is intended.

Giant recurrence of a multiple agminated Spitz nevus

An 11-year-old boy had multiple agminated pigmented lesions distributed over the left scapula since the age of 2 years. Shave excision of four grouped lesions showed Spitz nevi (benign juvenile melanoma, spindle or epithelioid cell nevi) that were not totally excised basally. Three years later, a tumorous, keloidlike nodule developed on that site. To the best of our knowledge, giant recurrence within an agminated Spitz nevus has not previously been reported.

Important melanocytic lesions in childhood and adolescence

Melanocytic nevi are common in children and adolescents, and the preponderance of these lesions are benign. Congenital melanocytic nevi, dysplastic nevi, and large numbers of common acquired nevi, however, may indicate an increased risk of malignant melanoma. With the exception, possibly, of giant congenital nevi, melanoma associated with these lesions generally occurs in adulthood. Nonetheless, some patients can be identified as being at increased risk for the development of melanoma during childhood. The poor prognosis associated with advanced melanoma and the curability of early lesions underscore the importance of prompt recognition of melanoma when it does occur in children. Furthermore, physicians who care for children are in a key position to decrease risk of melanoma throughout the lifespan by encouraging avoidance of excessive sun exposure during childhood.