Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2023;13(1):e2023046 1

Atypical Verrucous Presentation of Spitz Nevus
Awatef Kelati1,2,3,4, Kenza Oqbani5, Soumia Chiheb1

1 Dermatology department, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), 

Casablanca, Morocco

2 Member of the International Dermoscopy Society Task Force of dark skin’s imaging

3 Non-invasive skin imaging group of the French Society of Dermatology

4 Non-invasive skin imaging group of the Moroccan Society of Dermatology

5 Pathology department, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), 

Casablanca, Morocco

Citation: Kelati A, Oqbani K, Chiheb S. Atypical Verrucous Presentation Of Spitz Nevus. Dermatol Pract Concept. 2023;13(1):e2023046. 
DOI: https://doi.org/10.5826/dpc.1301a46

Accepted: September 6, 2022; Published: January 2023

Copyright: ©2023 Kelati et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding Author: Kelati Awatef, Dermatology Department, Cheikh Khalifa International University Hospital, Mohammed VI 
University of Health Sciences (UM6SS), Casablanca, Morocco. E-mail: akelati@um6ss.ma

Case Presentation

A seven-year-old girl, without any medical history, presented 

with a 4-year history of an asymptomatic pigmented lesion on 

the left ankle, which started to change and to grow -  according 

to the family - since one year. Dermatological examination 

revealed a pigmented verrucous nodule of the left ankle 

( Figure 1A). No other lesions were found. Contact dermos-

copy revealed an irregular asymmetric peripheral network, 

and central white globular structures surrounding violaceus 

vessels in some spots (Figure 1B). Spitzoid melanoma, spitz 

tumor or collision tumor of spitz nevus and a viral wart were 

discussed. The lesion was excised, histopathology revealed a 

papillomatous lesion with a predominance of epithelioid me-

lanocytic cells, cellular maturation in the deep dermis, and 

absence of atypia or mitosis, which confirmed the diagnosis 

of verrucous spitz nevus, without any signs of malignancy or 

viral cytopathic changes (Figure 1C).

Teaching Point

Spitzoid melanocytic lesions represent a challenging spec-

trum frombenign spitz nevi to malignant spitzoid melanoma, 

because of the morphological and dermoscopic overlap be-

tween them [1,2]).

Spitz nevi arise more commonly in females, and in 

childhood but may occur at any age. There are 3 dermo-

scopic patterns that may be considered as suggestive of 

Spitz nevus: starburst pattern, regularly distributed dotted 

vessels and globular pattern with reticular depigmenta-

tion [2]. Although we report through this observation an 

atypical multicomponent pattern in a spitz nevus, excision 

should be performed in the case of an asymmetric lesion 

with a multicomponent pattern in order to rule out spit-

zoid melanoma.



2 Image Letter | Dermatol Pract Concept. 2023;13(1):e2023046

References

1. Moscarella E, Al Jalbout S, Piana S, et al. The stars within the 

melanocytic garden: unusual variants of Spitz naevi. Br J Derma-

tol. 2015;172(4):1045-1051. DOI: 10.1111/bjd.13347. PMID: 

25123161.

2. Lallas A, Apalla Z, Ioannides D, et al. Update on dermoscopy of 

Spitz/Reed naevi and management guidelines by the International 

Dermoscopy Society. Br J Dermatol. 2017;177(3):645-655. DOI: 

10.1111/bjd.15339. PMID: 28118479.

Figure 1. Spitz nevus. (A) Pigmented verrucous nodule of the left ankle. (B) Dermoscopy: irregular asymmetric 

peripheral black network (blue arrow) and central white globular structures (red arrows) surrounding violaceus 

vessels in some spots. (C) Histopathology (H&E, x40 magnification): papillomatous lesion with a predominance 

of epithelioid melanocytic cells, cellular maturation in the deep dermis, and absence of atypia or mitosis.