Dermatology: Practical and Conceptual


Letter  |  Dermatol Pract Concept 2019;9(3):19 237

Dermatology Practical & Conceptual

An 8-year-old boy presented with a well-demarcated pig-

mented lesion localized 5 cm above his right knee. His parents 

reported that it had appeared approximately 5 months before 

as a small pink-red papule initially diagnosed as a wart. 

Gradually, the lesion grew in size and developed a darker area 

in the center (Figure 1).

Dermoscopically, the lesion showed a multicomponent 

pattern with blue to black dots and globules, blue-white veil, 

and pinkish color, especially visible at the periphery (Figure 

2). Histological evaluation revealed a well-circumscribed 

dermoepidermal pigmented atypical melanocytic prolifera-

tion composed of epithelioid spindle cells (spitzoid cytology). 

A Strange Atypical Spitz Tumor
Andrea Bassi1, Vincenzo Piccolo2, Maurizio de Martino1, Teresa Oranges1,  

Cesare Filippeschi1, Giuseppe Argenziano2

1 Department of Health Sciences, University of Florence & Department of Paediatric Medicine, Anna Meyer Children’s University Hospital, 

Florence, Italy

2 Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy

Key words: dermoscopy, Spitz tumor, histopathology, atypical Spitz tumor

Citation: Bassi A, Piccolo V, de Martino M, Oranges T, Filippeschi C, Argenziano G. A strange atypical Spitz tumor. Dermatol Pract 
Concept. 2019;9(3):237-238. DOI: https://doi.org/10.5826/dpc.0903a19

Accepted: February 12, 2019; Published: July 31, 2019

Copyright: ©2019 Bassi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Vincenzo Piccolo, MD, c/o II Policlinico, Edificio 9, Primo piano, Via Pansini 5 - 80131 Napoli, Italy. Email: 
piccolo.vincenzo@gmail.com

Figure 1. Small pink-red 

papule on the right knee 

(0.8  × 1 cm) with a cross 

shape distribution of the pig-

ment. [Copyright: ©2019 

Bassi et al.]

Figure 2. Multicomponent pattern with blue to black dots 

and globules, blue-white veil, and pinkish color at the pe-

riphery of the lesion. [Copyright: ©2019 Bassi et al.]



238 Letter  |  Dermatol Pract Concept 2019;9(3):19

Melanocytes were mostly arranged in confluent fascicles, with 

retraction artifacts. There was prominent central and lateral 

pagetoid spread (Figure 3). A final diagnosis of atypical Spitz 

tumor (AST), with free margins, was made.

ASTs have been regarded as “borderline” melanocytic 

lesions with overlapping features with Spitz nevus and spit-

zoid melanoma, but their true biological significance is still 

poorly understood. Pediatric ASTs seem to be associated with 

minimal lethal potential. In our case the clinical diagnosis 

was not straightforward; the site and the patient’s age led 

us to suspect initially a Spitz with an atypical presentation 

[1]. The atypical dermoscopy presentation and the atypical 

melanocytic proliferation of spitzoid cells led us to the final 

diagnosis. Given the complexities in interpretation, great 

care should be given when dealing with spitzoid lesions that 

show any degree of deviation from the classic features of 

Spitz nevus.

Reference

1. Moscarella E, Piccolo V, Argenziano G, et al. Problematic lesions 

in children. Dermatol Clin. 2013;31(4):535-547.

Figure 3. (A) Histopathological examination shows a raised, well-circumscribed, slightly asymmetric dermoepidermal atypical melanocytic 

proliferation associated with marked hyperkeratosis and irregular hyperplasia (H&E, original magnification ×2.5). (B) There is prominent 

central and lateral pagetoid spread of melanocytes and no epidermal ulceration (H&E, original magnification ×10). (C) Pigmented melano-

cytes display an epithelioid spindle (spitzoid) morphology and are mostly arranged in confluent fascicles with peripheral retraction artifacts 

(H&E, original magnification ×20). (D) Melanocytes show mild pleomorphism and are intermingled with numerous melanophages (H&E, 

original magnification ×40). H&E = hematoxylin and eosin. [Copyright: ©2019 Bassi et al.]

A

C

B

D