Adult Spitz Nevus

Deba P Sarma, MD Omaha

F 27, left leg, 4 mm 'mole'

The lesion is small (4mm), symmetrical, slightly raised and focally pigmented.

It is composed of junctional nested proliferation of moderately pleomorphic epitheliod nevocytes extending into the papillary dermis and gradually maturing into small bland nevus cell nests in deeper dermis.

The junctional epitheliod nevocytes show large amount of cytoplasm with mostly large bland nuclei. Some cells show dark nuclei with prominent nucleoli.

A few normal mitotic figures are seen in the superficial epitheliod part of the lesion, none in the deeper dermis.

Larger epitheliod cells gradually mature into small bland nevus cell nests in deeper dermis.

Larger epitheliod cells gradually mature into small bland nevus cell nests in deeper dermis.

Comment
-The lesion is small (4mm), symmetrical, slightly raised and focally pigmented. -It is composed of junctional nested proliferation of moderately pleomorphic epitheliod nevocytes extending into the papillary dermis and gradually maturing into small bland nevus cell nests in deeper dermis. -The overlying epidermis is intact and free of ulceration and it shows a few pagetoid melanocytic cells with bland nuclei. -The junctional epitheliod nevocytes show large amount of cytoplasm with mostly large bland nuclei. Some cells show dark nuclei with prominent nucleoli. -A few normal mitotic figures are seen in the superficial epitheliod part of the lesion, none in the deeper dermis. -No atypical mitosis or cell necrosis is present. -There is a mild chronic inflammatory cell infiltration in the dermis. -Overall picture is that of an epitheliod compound nevus ( adult Spitz nevus). There is no diagnostic feature of melanoma. In a 27-year-old female patient with an adult Spitz nevus of leg, a conservative re-excision of the previous biopsy site should be considered.