ATYPICAL SPITZ NEVUS / MELANOMA SPITZ IN A 6-YEARS OLD CHILD: CASE REPORT

Case Report: Female patient, 6 years old, mother reporting a slowly growing melanocytic lesion on abdomen skin in the last 3 years. The lesion had a classic starburst shape on the dermatoscopic exam. Submitted to excisional biopsy with pathologic exam suggesting atypical Spitz nevus, 3 cm in size, Clark level IV, 2 mm thickness, perineural invasion and absence of ulceration. Patient was referred to wide margins excision and sentinel lymph node biopsy, which migrated to the left groin region. Final pathology report demonstrated absence of residual disease and two sentinel lymph nodes free of melanoma. - Discussion: Based on clinical and histopathological criteria, Spitz tumors can be classified as classic Spitz, atypical Spitz, and melanoma Spitz. It is a rare condition with a estimated incidence of 1.4 to 7 new cases per 100.000 inhabitants per year. It most affects the adolescent and young adults populations and usually has a benign behavior. Atypical Spitz nevus (ASN) corresponds to a minority of cases and its clinical relevance lies in the close histological resemblance to invasive melanoma, with disagreement even among expert pathologists. Incidences of ASN or melanoma in children under 9 years old are uncommon and its management is often difficult and challenging. In the reported case, characteristics such as perineural invasion of branch nerve > 1mm, Clark IV infiltration level and the presence of mitoses confer an aggressive histological behavior, rarely observed in this age group. - Final comments: Atypical Spitz nevus in a 6-year-old child with clinical and pathological difficulty distinguishing between invasive melanoma

Publication History

Article published online:
23 October 2019