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Benton S, Roth A, Khan AU, Zhao J, Kim D, Compres EV, Wagner AM, Kruse LL, Zhang B, Gerami P. Risk factors for the development of Spitz neoplasms. Pediatr Dermatol 2022; 39:220-225. [PMID: 35187702 PMCID: PMC9306590 DOI: 10.1111/pde.14957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES The principal environmental risk factor for conventional nevi and melanomas is ultraviolet exposure. However, little is known about genetic or environmental risk factors for developing Spitz tumors. This study investigates risk factors associated with Spitz neoplasms. METHODS Patients with Spitz tumors seen at Northwestern Memorial Hospital and Lurie Children's Hospital were surveyed with a 16-item questionnaire about environmental and inherited factors. Spitz tumor patients were compared to a pediatric control cohort from a similar clinical setting. This was supplemented with a meta-analysis of genetic and environmental causes of Spitz neoplasms. RESULTS One hundred and six Spitz and 58 control surveys were obtained and no statistically significant differences in genetic or environmental risk factors were found between Spitz and control groups. CONCLUSION Our data and meta-analysis suggest that typical risk factors associated with melanoma are not significantly associated with Spitz tumors. Identification of relevant genetic or environmental risk factors will likely require larger and population-based studies.
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Affiliation(s)
- Sarah Benton
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Andrew Roth
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ayesha U Khan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jeffrey Zhao
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Daniel Kim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elsy V Compres
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Annette M Wagner
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Lacey L Kruse
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Bin Zhang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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2
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Management of Residual Spitz Nevus in Surgical Specimens following Biopsy and Excision. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3244. [PMID: 33425580 PMCID: PMC7787304 DOI: 10.1097/gox.0000000000003244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/18/2020] [Indexed: 11/26/2022]
Abstract
Proper management of Spitz nevi continues to be debated, with treatment ranging from observation to surgery. To better characterize the outcome of surgical procedures performed for incomplete initial excision or biopsy, we sought to ascertain the histopathological presence of residual Spitz nevi in a set of surgical specimens. Methods We retrospectively reviewed 123 records with histologically-confirmed Spitz nevus. Data concerning treatment, clinical features, histopathological margin involvement, and presence of residual lesion on subsequent procedural specimens were collected. Results Fifty-three percent of lesions (n = 65) were initially sampled by shave or punch biopsy, and the remainder (n = 58) were formally excised without initial biopsy. The rates of re-excision for involved margins were: shave biopsy (92.2%), punch biopsy (78.6%), and formal excision (13.8%). In total, 61.0% of patients who underwent an initial procedure of any kind had involved margins, but only half of those re-excised for involved margins (57.6%) had histologically residual lesion on repeated excision. A significantly higher proportion of initial punch biopsies (90.9%) resulted in residual lesion (in secondary excision specimens) when compared with shave biopsy (48.9%) and formal excision (62.5%; P < 0.05). Conclusions Findings suggest that clinicians may consider shave biopsy over punch biopsy for diagnosing suspected lesions, when indicated and appropriate. Given the rarity of malignant transformation and the frequency of residual nevus, observation may be reasonable for managing pediatric patients with histologically-confirmed Spitz nevi, who are post initial biopsy or excision despite known histopathological margin involvement.
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3
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Kaushik A, Natsis N, Gordon SC, Seiverling EV. A practical review of dermoscopy for pediatric dermatology part I: Melanocytic growths. Pediatr Dermatol 2020; 37:789-797. [PMID: 32748996 DOI: 10.1111/pde.14291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The value of dermoscopy in the detection of skin cancer is well established. Less is published on the utility of dermoscopy in the evaluation of pediatric skin disease. Our review (in two parts) aims to serve as an update on pediatric dermoscopy and to provide readers with a practical application for the use of dermoscopy in pediatric dermatology clinics. In part I, we propose a dermoscopy algorithm for pediatric skin disease and melanocytic growths, and in part II, we address vascular growths, common skin infections, and inflammatory conditions for which dermoscopy is valuable.
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Affiliation(s)
- Anshika Kaushik
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA.,Department of Dermatology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Nicola Natsis
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA.,University of California San Diego School of Medicine, San Diego, CA, USA
| | | | - Elizabeth V Seiverling
- Department of Dermatology, Tufts Medical Center, Boston, MA, USA.,Division of Dermatology, Maine Medical Center & Maine Medical Partners, Portland, ME, USA
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4
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Sainz-Gaspar L, Sánchez-Bernal J, Noguera-Morel L, Hernández-Martín A, Colmenero I, Torrelo A. Nevo de Spitz y otros tumores spitzoides en la infancia. Parte 1: aspectos clínicos, histológicos e inmunohistoquímicos. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:7-19. [DOI: 10.1016/j.ad.2019.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/03/2019] [Indexed: 11/25/2022] Open
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5
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Sainz-Gaspar L, Sánchez-Bernal J, Noguera-Morel L, Hernández-Martín A, Colmenero I, Torrelo A. Spitz Nevus and Other Spitzoid Tumors in Children —Part 1: Clinical, Histopathologic, and Immunohistochemical Features. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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6
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Nestin Expression in Spitzoid Lesions: An Immunohistochemical Characterization With Clinical and Dermoscopic Correlations. Appl Immunohistochem Mol Morphol 2019; 27:430-435. [DOI: 10.1097/pai.0000000000000653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Dinnes J, Deeks JJ, Chuchu N, Ferrante di Ruffano L, Matin RN, Thomson DR, Wong KY, Aldridge RB, Abbott R, Fawzy M, Bayliss SE, Grainge MJ, Takwoingi Y, Davenport C, Godfrey K, Walter FM, Williams HC. Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults. Cochrane Database Syst Rev 2018; 12:CD011902. [PMID: 30521682 PMCID: PMC6517096 DOI: 10.1002/14651858.cd011902.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Melanoma has one of the fastest rising incidence rates of any cancer. It accounts for a small percentage of skin cancer cases but is responsible for the majority of skin cancer deaths. Although history-taking and visual inspection of a suspicious lesion by a clinician are usually the first in a series of 'tests' to diagnose skin cancer, dermoscopy has become an important tool to assist diagnosis by specialist clinicians and is increasingly used in primary care settings. Dermoscopy is a magnification technique using visible light that allows more detailed examination of the skin compared to examination by the naked eye alone. Establishing the additive value of dermoscopy over and above visual inspection alone across a range of observers and settings is critical to understanding its contribution for the diagnosis of melanoma and to future understanding of the potential role of the growing number of other high-resolution image analysis techniques. OBJECTIVES To determine the diagnostic accuracy of dermoscopy alone, or when added to visual inspection of a skin lesion, for the detection of cutaneous invasive melanoma and atypical intraepidermal melanocytic variants in adults. We separated studies according to whether the diagnosis was recorded face-to-face (in-person), or based on remote (image-based), assessment. SEARCH METHODS We undertook a comprehensive search of the following databases from inception up to August 2016: CENTRAL; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. SELECTION CRITERIA Studies of any design that evaluated dermoscopy in adults with lesions suspicious for melanoma, compared with a reference standard of either histological confirmation or clinical follow-up. Data on the accuracy of visual inspection, to allow comparisons of tests, was included only if reported in the included studies of dermoscopy. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). We contacted authors of included studies where information related to the target condition or diagnostic threshold were missing. We estimated accuracy using hierarchical summary receiver operating characteristic (SROC),methods. Analysis of studies allowing direct comparison between tests was undertaken. To facilitate interpretation of results, we computed values of sensitivity at the point on the SROC curve with 80% fixed specificity and values of specificity with 80% fixed sensitivity. We investigated the impact of in-person test interpretation; use of a purposely developed algorithm to assist diagnosis; observer expertise; and dermoscopy training. MAIN RESULTS We included a total of 104 study publications reporting on 103 study cohorts with 42,788 lesions (including 5700 cases), providing 354 datasets for dermoscopy. The risk of bias was mainly low for the index test and reference standard domains and mainly high or unclear for participant selection and participant flow. Concerns regarding the applicability of study findings were largely scored as 'high' concern in three of four domains assessed. Selective participant recruitment, lack of reproducibility of diagnostic thresholds and lack of detail on observer expertise were particularly problematic.The accuracy of dermoscopy for the detection of invasive melanoma or atypical intraepidermal melanocytic variants was reported in 86 datasets; 26 for evaluations conducted in person (dermoscopy added to visual inspection), and 60 for image-based evaluations (diagnosis based on interpretation of dermoscopic images). Analyses of studies by prior testing revealed no obvious effect on accuracy; analyses were hampered by the lack of studies in primary care, lack of relevant information and the restricted inclusion of lesions selected for biopsy or excision. Accuracy was higher for in-person diagnosis compared to image-based evaluations (relative diagnostic odds ratio (RDOR) 4.6, 95% confidence interval (CI) 2.4 to 9.0; P < 0.001).We compared accuracy for (a), in-person evaluations of dermoscopy (26 evaluations; 23,169 lesions and 1664 melanomas),versus visual inspection alone (13 evaluations; 6740 lesions and 459 melanomas), and for (b), image-based evaluations of dermoscopy (60 evaluations; 13,475 lesions and 2851 melanomas),versus image-based visual inspection (11 evaluations; 1740 lesions and 305 melanomas). For both comparisons, meta-analysis found dermoscopy to be more accurate than visual inspection alone, with RDORs of (a), 4.7 (95% CI 3.0 to 7.5; P < 0.001), and (b), 5.6 (95% CI 3.7 to 8.5; P < 0.001). For a), the predicted difference in sensitivity at a fixed specificity of 80% was 16% (95% CI 8% to 23%; 92% for dermoscopy + visual inspection versus 76% for visual inspection), and predicted difference in specificity at a fixed sensitivity of 80% was 20% (95% CI 7% to 33%; 95% for dermoscopy + visual inspection versus 75% for visual inspection). For b) the predicted differences in sensitivity was 34% (95% CI 24% to 46%; 81% for dermoscopy versus 47% for visual inspection), at a fixed specificity of 80%, and predicted difference in specificity was 40% (95% CI 27% to 57%; 82% for dermoscopy versus 42% for visual inspection), at a fixed sensitivity of 80%.Using the median prevalence of disease in each set of studies ((a), 12% for in-person and (b), 24% for image-based), for a hypothetical population of 1000 lesions, an increase in sensitivity of (a), 16% (in-person), and (b), 34% (image-based), from using dermoscopy at a fixed specificity of 80% equates to a reduction in the number of melanomas missed of (a), 19 and (b), 81 with (a), 176 and (b), 152 false positive results. An increase in specificity of (a), 20% (in-person), and (b), 40% (image-based), at a fixed sensitivity of 80% equates to a reduction in the number of unnecessary excisions from using dermoscopy of (a), 176 and (b), 304 with (a), 24 and (b), 48 melanomas missed.The use of a named or published algorithm to assist dermoscopy interpretation (as opposed to no reported algorithm or reported use of pattern analysis), had no significant impact on accuracy either for in-person (RDOR 1.4, 95% CI 0.34 to 5.6; P = 0.17), or image-based (RDOR 1.4, 95% CI 0.60 to 3.3; P = 0.22), evaluations. This result was supported by subgroup analysis according to algorithm used. We observed higher accuracy for observers reported as having high experience and for those classed as 'expert consultants' in comparison to those considered to have less experience in dermoscopy, particularly for image-based evaluations. Evidence for the effect of dermoscopy training on test accuracy was very limited but suggested associated improvements in sensitivity. AUTHORS' CONCLUSIONS Despite the observed limitations in the evidence base, dermoscopy is a valuable tool to support the visual inspection of a suspicious skin lesion for the detection of melanoma and atypical intraepidermal melanocytic variants, particularly in referred populations and in the hands of experienced users. Data to support its use in primary care are limited, however, it may assist in triaging suspicious lesions for urgent referral when employed by suitably trained clinicians. Formal algorithms may be of most use for dermoscopy training purposes and for less expert observers, however reliable data comparing approaches using dermoscopy in person are lacking.
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Affiliation(s)
- Jacqueline Dinnes
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Jonathan J Deeks
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Naomi Chuchu
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | | | - Rubeta N Matin
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LE
| | | | - Kai Yuen Wong
- Oxford University Hospitals NHS Foundation TrustDepartment of Plastic and Reconstructive SurgeryOxfordUK
| | - Roger Benjamin Aldridge
- NHS Lothian/University of EdinburghDepartment of Plastic Surgery25/6 India StreetEdinburghUKEH3 6HE
| | - Rachel Abbott
- University Hospital of WalesWelsh Institute of DermatologyHeath ParkCardiffUKCF14 4XW
| | - Monica Fawzy
- Norfolk and Norwich University Hospital NHS TrustDepartment of Plastic and Reconstructive SurgeryColney LaneNorwichUKNR4 7UY
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Matthew J Grainge
- School of MedicineDivision of Epidemiology and Public HealthUniversity of NottinghamNottinghamUKNG7 2UH
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Clare Davenport
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Kathie Godfrey
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
| | - Fiona M Walter
- University of CambridgePublic Health & Primary CareStrangeways Research Laboratory, Worts CausewayCambridgeUKCB1 8RN
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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8
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Lallas A, Apalla Z, Ioannides D, Lazaridou E, Kyrgidis A, Broganelli P, Alfano R, Zalaudek I, Argenziano G. Update on dermoscopy of Spitz/Reed naevi and management guidelines by the International Dermoscopy Society. Br J Dermatol 2017; 177:645-655. [PMID: 28118479 DOI: 10.1111/bjd.15339] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 01/23/2023]
Abstract
Spitzoid lesions represent a challenging and controversial group of tumours, in terms of clinical recognition, biological behaviour and management strategies. Although Spitz naevi are considered benign tumours, their clinical and dermoscopic morphological overlap with spitzoid melanoma renders the management of spitzoid lesions particularly difficult. The controversy deepens because of the existence of tumours that cannot be safely histopathologically diagnosed as naevi or melanomas (atypical Spitz tumours). The dual objective of the present study was to provide an updated classification on dermoscopy of Spitz naevi, and management recommendations of spitzoid-looking lesions based on a consensus among experts in the field. After a detailed search of the literature for eligible studies, a data synthesis was performed from 15 studies on dermoscopy of Spitz naevi. Dermoscopically, Spitz naevi are typified by three main patterns: starburst pattern (51%), a pattern of regularly distributed dotted vessels (19%) and globular pattern with reticular depigmentation (17%). A consensus-based algorithm for the management of spitzoid lesions is proposed. According to it, dermoscopically asymmetric lesions with spitzoid features (both flat/raised and nodular) should be excised to rule out melanoma. Dermoscopically symmetric spitzoid nodules should also be excised or closely monitored, irrespective of age, to rule out atypical Spitz tumours. Dermoscopically symmetric, flat spitzoid lesions should be managed according to the age of the patient. Finally, the histopathological diagnosis of atypical Spitz tumour should warrant wide excision but not a sentinel lymph-node biopsy.
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Affiliation(s)
- A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Z Apalla
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - D Ioannides
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - E Lazaridou
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - A Kyrgidis
- Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - P Broganelli
- City of Health and Science University, Turin, Italy
| | - R Alfano
- Department of Anaesthesiology, Surgery and Emergency Medicine, Second University of Naples, Naples, Italy
| | - I Zalaudek
- Department of Dermatology and Venereology, Nonmelanoma Skin Cancer Unit, Medical University of Graz, Austria
| | - G Argenziano
- Dermatology Unit, Second University of Naples, Naples, Italy
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9
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Abstract
BACKGROUND/OBJECTIVES Spitz nevi are melanocytic lesions with clinical, dermoscopic, and histopathologic presentations that may resemble those of melanoma. The evolution of Spitz nevi is a well-known feature. The objectives of this study were to investigate the clinical and dermoscopic features of Spitz nevi and define their evolution. METHODS A retrospective observational study was performed and 70 Spitz nevi were analyzed using clinical and dermoscopic examination. RESULTS Seventy patients were included in the study. The most common dermoscopic pattern was globular (n = 35 [50%]) followed by starburst (n = 24 [34.3%]), reticular (n = 8 [11.4%]), and homogeneous (n = 3 [4.3%]). Follow-up data were available for 27 of 70 patients. Of these, 21 demonstrated evolution on the follow-up images. A stable pattern (no evolution) was noted in 6 of 27 lesions. The patients who exhibited evolution were younger on average than the stable group (p = 0.04). CONCLUSION Based on our study, the most common biologic behavior for Spitz nevi is evolution. Although no significant differences were observed in other clinical features, the inverse relationship between evolution and age is important to consider when attempting to differentiate Spitz nevus from melanoma.
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Affiliation(s)
- Nazan Emiroglu
- Department of Dermatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Pelin Yıldız
- Department of Pathology, Bezmialem Vakif University, Istanbul, Turkey
| | | | | | - Ozlem Su
- Department of Dermatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Nahide Onsun
- Department of Dermatology, Bezmialem Vakif University, Istanbul, Turkey
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10
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Dika E, Neri I, Fanti PA, Barisani A, Ravaioli GM, Patrizi A. Spitznävi: unterschiedliche klinische, dermatoskopische und histopathologische Merkmale in der Kindheit. J Dtsch Dermatol Ges 2017; 15:70-76. [DOI: 10.1111/ddg.12904_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/30/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Emi Dika
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Italien
| | - Iria Neri
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Italien
| | - Pier Alessandro Fanti
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Italien
| | - Alessia Barisani
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Italien
| | - Giulia Maria Ravaioli
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Italien
| | - Annalisa Patrizi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna; Italien
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11
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Dika E, Ravaioli GM, Fanti PA, Neri I, Patrizi A. Spitz Nevi and Other Spitzoid Neoplasms in Children: Overview of Incidence Data and Diagnostic Criteria. Pediatr Dermatol 2017; 34:25-32. [PMID: 27874206 DOI: 10.1111/pde.13025] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Spitz nevi are benign melanocytic neoplasms characterized by epithelioid or spindle melanocytes or both. In some rare cases their presentation overlaps with the clinical and histopathologic features of malignant melanoma, so a differential diagnosis can be difficult to make. Intermediate forms between Spitz nevi and malignant melanoma, with unpredictable behavior, have been called atypical Spitz tumors. A literature search was performed to review the clinical, dermoscopic, genetic, and histopathologic aspects of spitzoid tumors. Spitz nevi mainly occur in children, with no predilection for sex, and in young women. Common sites are the head and lower arms, where Spitz nevi present as pink nodules or hyperpigmented plaques. Spitzoid lesions may have diverse dermoscopic patterns: vascular, starburst, globular, atypical, reticular, negative homogeneous, or targetoid. The management of spitzoid lesions can be invasive or conservative; surgical excision is usually reserved for those with doubtful features, whereas clinical and dermoscopic follow-up is preferred for typical pediatric Spitz nevi. The role of sentinel lymph node biopsy in atypical Spitz tumors is debated. Immunohistochemistry and new molecular techniques such as comparative genomic hybridization, polymerase chain reaction, and fluorescence in situ hybridization offer new diagnostic perspectives, investigating genetic alterations that are specific for malignant melanoma or for Spitz nevi.
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Affiliation(s)
- Emi Dika
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Giulia Maria Ravaioli
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Pier Alessandro Fanti
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Iria Neri
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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12
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Dika E, Neri I, Fanti PA, Barisani A, Ravaioli GM, Patrizi A. Spitz nevi: diverse clinical, dermatoscopic and histopathological features in childhood. J Dtsch Dermatol Ges 2016; 15:70-75. [PMID: 27860221 DOI: 10.1111/ddg.12904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/30/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES The characterization of clinical features and biological potential of Spitz nevi has attracted a lot of interest in past decades. The aim of our paper was to describe the clinical, dermatoscopic features as well as the clinical outcome of surgically excised Spitz nevi in three different pediatric age groups. PATIENTS AND METHODS A retrospective study analyzing clinical features, videodermatoscopic images, histopathological diagnosis and patient outcome. The level of pigmentation was evaluated both clinically and histopathologically. RESULTS 72 spitzoid neoplasms were excised from 71 pediatric patients. Videodermatoscopic images were available for 41 patients. The distribution of pigmentation significantly correlated with patient age: hyperpigmented lesions were rather rare in preschool children, becoming more frequent in patients aged 7 to 12 years and older than 13 years. The histopathological diagnosis of atypical Spitz nevus was uncommon. None of the patients originally diagnosed with atypical Spitz nevi developed local recurrence or metastases during subsequent follow-up. CONCLUSIONS Pigmented Spitz nevi were more common after 13 years of age. The study confirms other reports regarding the distribution of pigmentation patterns, and underlines the low number of atypical Spitz nevi in pediatric patients as well as their low recurrence rate during long-term follow-up.
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Affiliation(s)
- Emi Dika
- Dermatology, Department of -Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Iria Neri
- Dermatology, Department of -Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Pier Alessandro Fanti
- Dermatology, Department of -Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Alessia Barisani
- Dermatology, Department of -Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Giulia Maria Ravaioli
- Dermatology, Department of -Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Annalisa Patrizi
- Dermatology, Department of -Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
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13
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Guida S, Pellacani G, Cesinaro A, Moscarella E, Argenziano G, Farnetani F, Bonamonte D, Longo C. Spitz naevi and melanomas with similar dermoscopic patterns: can confocal microscopy differentiate? Br J Dermatol 2015; 174:610-6. [DOI: 10.1111/bjd.14286] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 11/29/2022]
Affiliation(s)
- S. Guida
- Dermatology Unit; University of Modena and Reggio Emilia; Reggio Emilia Italy
| | - G. Pellacani
- Dermatology Unit; University of Modena and Reggio Emilia; Reggio Emilia Italy
| | - A.M. Cesinaro
- Pathology Unit; University of Modena and Reggio Emilia; Reggio Emilia Italy
| | - E. Moscarella
- Skin Cancer Unit; Arcispedale S. Maria Nuova-IRCCS; Viale Risorgimento 80 42100 Reggio Emilia Italy
| | - G. Argenziano
- Dermatology Unit; Second University of Naples; Naples Italy
| | - F. Farnetani
- Dermatology Unit; University of Modena and Reggio Emilia; Reggio Emilia Italy
| | - D. Bonamonte
- Dermatology Unit; University of Bari ‘Aldo Moro’; Bari Italy
| | - C. Longo
- Skin Cancer Unit; Arcispedale S. Maria Nuova-IRCCS; Viale Risorgimento 80 42100 Reggio Emilia Italy
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Lallas A, Moscarella E, Longo C, Kyrgidis A, de Mestier Y, Vale G, Guida S, Pellacani G, Argenziano G. Likelihood of finding melanoma when removing a Spitzoid-looking lesion in patients aged 12 years or older. J Am Acad Dermatol 2015; 72:47-53. [DOI: 10.1016/j.jaad.2014.09.037] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/09/2014] [Accepted: 09/17/2014] [Indexed: 11/26/2022]
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15
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Malkan AD, Sandoval JA. Controversial tumors in pediatric surgical oncology. Curr Probl Surg 2014; 51:478-520. [PMID: 25524425 DOI: 10.1067/j.cpsurg.2014.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/17/2014] [Indexed: 12/13/2022]
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16
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Saravia M, Pellicer Z, Martin J, Monteagudo C. Clinically atypical spitzoid lesions: semi-quantitative histologic index correlation with dermoscopic scores (ABCD rule, 7-point checklist and pattern analysis). J Eur Acad Dermatol Venereol 2014; 29:668-72. [DOI: 10.1111/jdv.12649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/17/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M. Saravia
- Hospital Clínico Universitario de Valencia/INCLIVA; University of Valencia; Valencia Spain
| | - Z. Pellicer
- Hospital Clínico Universitario de Valencia/INCLIVA; University of Valencia; Valencia Spain
| | - J.M. Martin
- Hospital Clínico Universitario de Valencia/INCLIVA; University of Valencia; Valencia Spain
| | - C. Monteagudo
- Hospital Clínico Universitario de Valencia/INCLIVA; University of Valencia; Valencia Spain
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17
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Moscarella E, Zalaudek I, Ferrara G, Manzo M, Savarese I, Argenziano G. Problematic melanocytic lesions in children. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.09.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Zalaudek I, Leinweber B, Hofmann-Wellenhof R, Soyer HP. The impact of dermoscopic–pathological correlates in the diagnosis and management of pigmented skin tumors. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.1.4.579] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Moscarella E, Piccolo V, Argenziano G, Lallas A, Longo C, Castagnetti F, Pizzigoni S, Zalaudek I. Problematic Lesions in Children. Dermatol Clin 2013; 31:535-47, vii. [DOI: 10.1016/j.det.2013.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Moscarella E, Zalaudek I, Cerroni L, Sperduti I, Catricalà C, Smolle J, Hofmann-Wellenhof R, Sgambato A, Pellacani G, Argenziano G. Excised melanocytic lesions in children and adolescents - a 10-year survey. Br J Dermatol 2012; 167:368-73. [PMID: 22428965 DOI: 10.1111/j.1365-2133.2012.10952.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early recognition and prompt excision is to date the only available strategy for reducing mortality from melanoma. Little is known about the accuracy of melanoma detection in children and adolescents. OBJECTIVES To assess the accuracy of melanoma detection in a paediatric population. METHODS From the Department of Dermatology, Medical University of Graz, Austria, we reviewed the dermatopathology reports of naevi and melanomas excised in patients younger than 20 years over a 10-year period (1998-2007). Patients were subdivided into four age groups: 0-4, 5-9, 10-14 and 15-19 years. RESULTS Accuracy in melanoma detection was tested using the number needed to excise (NNE) value that is obtained by dividing the total number of excised lesions by the number of melanomas. A total of 22564 lesions were reviewed, disclosing 22526 naevi and 38 melanomas, for an overall NNE value of 593.8. Five melanomas were excised in children aged 10-14 years (NNE 1141) and 33 in children aged 15-19 years (NNE 479.8), whereas no melanomas were found among 1026 lesions excised in children younger than 10 years. In children aged 0-4 years, congenital and Spitz/Reed naevi accounted for 34.5% and 20% of lesions, respectively. These percentages decreased progressively when moving to older age groups (P<0.0001). In contrast, the percentage of dermal and compound naevi rose in direct proportion with age, being 3.4% and 20.7%, respectively, in the youngest age group, and 36.7% and 31.9%, respectively, among the oldest patients (P<0.0001). CONCLUSIONS The overall NNE value in paediatric patients over the 10-year study period was 593.8, meaning that about 594 lesions were excised to find one melanoma. This value is 20 times higher than the rates found in adult patients.
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Affiliation(s)
- E Moscarella
- Department of Oncological Dermatology, Santa Maria and San Gallicano Dermatologic Institute, Rome, Italy
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21
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Yoradjian A, Enokihara MMSES, Paschoal FM. Spitz nevus and Reed nevus. An Bras Dermatol 2012; 87:349-57; quiz 358-9. [DOI: 10.1590/s0365-05962012000300001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 04/04/2011] [Indexed: 11/22/2022] Open
Abstract
Spitz and Reed nevi, also called spindle and/or epithelioid cell nevi, are a special group of melanocytic lesions due to their peculiar clinical, dermoscopic and histopathological features. The study of these nevi is of great interest because both their nomenclature and classification are still a matter of discussion. Most importantly, the difficulty to differentiate them from melanoma can lead to inadequate therapies. In this context, dermoscopy, a link between clinical and anatomopathological examinations, appears as a helpful diagnostic tool whose accuracy can reach 93%. "Borderline" lesions are still a great challenge and object of research, including molecular studies. The present study explores the relevant characteristics of these nevi, with emphasis on dermoscopic findings, aiming at understanding their natural history, as well as discussing treatment and patient follow-up.
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22
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Luo S, Sepehr A, Tsao H. Spitz nevi and other Spitzoid lesions part I. Background and diagnoses. J Am Acad Dermatol 2011; 65:1073-84. [PMID: 22082838 DOI: 10.1016/j.jaad.2011.04.040] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 04/21/2011] [Accepted: 04/23/2011] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Su Luo
- Wellman Center for Photomedicine and Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
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23
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Webber SA, Siller G, Soyer HP. Pigmented spindle cell naevus of Reed: a controversial diagnostic entity in Australia. Australas J Dermatol 2011; 52:104-8. [PMID: 21605093 DOI: 10.1111/j.1440-0960.2011.00743.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES The Reed naevus or pigmented spindle cell naevus of Reed (PSCN) was previously considered a pigmented variant of the spindle cell-type of Spitz naevus. It is now considered a distinct entity and may overlap with cutaneous melanoma in both clinical and dermatoscopic features. We hypothesised that PSCN is an under-recognised entity in Australia and present a typical case. To test our hypothesis, we performed a clinically based survey of Australian dermatology trainees (Registrars). A further aim of our study was to determine the approach of dermatology trainees in this country to the management of this type of lesion. METHODS A web-based survey questionnaire based on the presented case was circulated to trainees of the Australasian College of Dermatologists. Responses, including level of training and initial approach to management, were collated and form the basis of the results presented herein. RESULTS Of 39 respondents, 13 (33%) diagnosed the lesion as PSCN. The majority (33/39; 84.6%) indicated they would biopsy the lesion, with most of these (91%) preferring excisional biopsy. CONCLUSIONS The results support our hypothesis that PSCN is under-recognised in Australia. The results also show that despite difficulty distinguishing this lesion, management of these lesions by dermatology trainees in Australia is consistent and parallels current recommendations.
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Affiliation(s)
- Scott A Webber
- Department of Dermatology, Princess Alexandra Hospital, Queensland, Australia.
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Pinheiro AMC, Pereira GA, Amorin AG, Varella TCN, Friedman H. Nevo de Spitz: relato de caso e dermatoscopia. An Bras Dermatol 2010; 85:555-7. [DOI: 10.1590/s0365-05962010000400021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 02/22/2010] [Indexed: 11/22/2022] Open
Abstract
O nevo de Spitz é uma lesão melanocítica benigna com características clínicas e histopatológicas semelhantes às do melanoma. Foi descrito em 1948, mas até hoje, ainda, existe grande controvérsia no seu diagnóstico e conduta. A utilização da dermatoscopia pode aumentar a sua acurácia diagnóstica. As características dermatoscópicas do nevo de Spitz incluem um padrão estelar (starburst), que é o mais frequente, seguido do padrão globular e do padrão atípico. O diagnóstico deve ser confirmado por exame histopatológico, principalmente, nos casos atípicos.
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Boneti KK, Piñeiro-Maceira J, Pereira FBC, Barcaui CB. Nevo de Reed (nevo de células fusiformes): relato de três casos com padrões dermatoscópicos distintos. An Bras Dermatol 2010; 85:531-6. [DOI: 10.1590/s0365-05962010000400016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 07/31/2009] [Indexed: 11/21/2022] Open
Abstract
O nevo de Reed ou nevo de células fusiformes pigmentado pode ser um simulador do melanoma cutâneo. Apresenta, entretanto, diferentes características dermatoscópicas e histopatológicas. Trata-se de relato de três pacientes com apresentações clínicas, dermatoscópicas e histopatológicas distintas, correlacionando-as no auxílio diagnóstico deste com o melanoma e nevo de Sptiz.
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Pellacani G, Longo C, Ferrara G, Cesinaro AM, Bassoli S, Guitera P, Menzies SW, Seidenari S. Spitz nevi: In vivo confocal microscopic features, dermatoscopic aspects, histopathologic correlates, and diagnostic significance. J Am Acad Dermatol 2009; 60:236-47. [DOI: 10.1016/j.jaad.2008.07.061] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 07/11/2008] [Accepted: 07/14/2008] [Indexed: 11/27/2022]
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Dermoscopic Features of Difficult Melanoma. Dermatol Surg 2007. [DOI: 10.1097/00042728-200701000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Pizzichetta MA, Stanganelli I, Bono R, Soyer HP, Magi S, Canzonieri V, Lanzanova G, Annessi G, Massone C, Cerroni L, Talamini R. Dermoscopic Features of Difficult Melanoma. Dermatol Surg 2007; 33:91-9. [PMID: 17214687 DOI: 10.1111/j.1524-4725.2007.33015.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The dermoscopic diagnosis of cutaneous melanoma (CM) may be difficult because some CM lack specific dermoscopic features for melanoma diagnosis. OBJECTIVE To evaluate whether a diagnosis of CM could be achieved using the classic dermoscopic melanoma-specific criteria, we conducted a retrospective multicenter study of 508 CM samples. METHODS All the dermoscopic images were analyzed to identify the dermoscopic criteria found in dermoscopically difficult melanomas (DDM) and to examine the possible relation of dermoscopic diagnosis with respect to the difficulty of the dermoscopic diagnosis and the melanoma thickness. RESULTS A significant percentage of melanomas, 89 of 508 (17.5%), were DDM. The criteria leading to a significant increased risk of DDM were presence of streaks [odds ratio (OR), 2.26; 95% confidence interval (CI), 1.15-4.47), absence or presence of regular pigmentation (OR, 3.41; 95% CI, 1.70-6.85), absence of a blue-whitish veil (OR, 4.04; 95% CI, 2.33-6.99), absence of regression structures (OR, 4.31; 95% CI, 2.42-7.66), and the presence of hypopigmentation (OR, 2.61; 95% CI, 1.49-4.58). CONCLUSION A significant number of melanomas defy even dermoscopic diagnosis. Only a meticulous comparative and interactive process based on an assessment of all the individual's other nevi ("ugly ducking" sign) and a knowledge about recent changes can lead to the recognition of DDM.
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Piccolo D, Altamura D, Lozzi GP, Peris K. Blue-whitish veil-like structure as the primary dermoscopic feature of combined nevus. Dermatol Surg 2006; 32:1176-8. [PMID: 16970701 DOI: 10.1111/j.1524-4725.2006.32262.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The combined nevus is a clinical simulator of melanoma, and clinical examination alone can be inadequate to diagnose this melanocytic pigmented skin lesion. Dermoscopy is a useful tool to differentiate the features related to each type of nevus. We report two cases of combined nevi dermoscopically characterized by a diffuse blue-whitish pigmentation similar to the blue-whitish veil, suggesting the diagnosis of melanoma.
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Affiliation(s)
- Domenico Piccolo
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy
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30
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Blue-Whitish Veil-like Structure as the Primary Dermoscopic Feature of Combined Nevus. Dermatol Surg 2006. [DOI: 10.1097/00042728-200609000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ferrari A, Lozzi GP, Fargnoli MC, Peris K. Dermoscopic Evolution of a Congenital Combined Nevus in Childhood. Dermatol Surg 2006; 31:1448-50. [PMID: 16416618 DOI: 10.2310/6350.2005.31215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND A combined nevus most commonly consists of a blue nevus in combination with a Clark or Spitz nevus. Dermoscopically, combined nevus can mimic melanoma owing to the presence of dermoscopic features common to both types of lesions. Benign clinical and dermoscopic changes can occur in nevi over time, especially in children and young adults. OBJECTIVE To describe the dermoscopic evolution of a congenital combined nevus showing unusual dermoscopic features. METHODS Digital dermoscopic analysis was performed at the initial visit and after 8 months. The lesion was surgically excised and histopathologically examined. RESULTS An asymptomatic plaque with a central blue area and peripheral brown pigmentation located on the back of a 13-year-old boy was diagnosed dermoscopically as combined nevus. Dermoscopic analysis 8 months later showed color changes from steel blue to gray-blue and black in the central area of the lesion, an increased number of blue-black dots or globules, and peripheral irregular streaks. Histopathology revealed typical features of a congenital combined nevus (blue nevus + compound nevus). CONCLUSION Over time, congenital combined nevus may show clinical and dermoscopic changes in size, color, and structure. Surgical excision is recommended when clinical and dermoscopic features are equivocal and the diagnosis of melanoma cannot be ruled out.
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Affiliation(s)
- Angela Ferrari
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy
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Dermoscopic Evolution of a Congenital Combined Nevus in Childhood. Dermatol Surg 2005. [DOI: 10.1097/00042728-200511000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Piccolo D, Ferrari A, Peris K. Sequential dermoscopic evolution of pigmented Spitz nevus in childhood. J Am Acad Dermatol 2003; 49:556-8. [PMID: 12963935 DOI: 10.1067/s0190-9622(03)00778-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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