Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2025;15(3):5464 1

Pediatric Case of Compound Spitz Nevus with 
Somatotropin Treatment: Rare Clinical Findings  

and Diagnostic Approach
Amanda do Carmo Gusmão1, Ana Clara Braga1, Gabriela dal Bosco Guarda1, Carlos Arthur 

de Figueiredo Athayde1, Luciana Pantaleão2, Juliane Lucio Coutinho dos Santos2

1 Dermatology Departament of Federal Fluminense University, Brazil 

2 Pathology Departament of Federal Fluminense University, Brazil 

Citation: Borges AC, Garda GDB, Athayde CAF, et al. Pediatric case of compound spitz nevus with somatotropin treatment: rare clinical 
findings and diagnostic approach. Dermatol Pract Concept. 2025;15(3):5464. DOI: https://doi.org/10.5826/dpc.1503a5464

Accepted: April 12, 2025; Published: July 2025

Copyright: ©2025 Borges 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: Ana Clara Borges, Federal Fluminense University, Brazil. E-mail: braga.anaclarab@gmail.com.  
ORCID 0000-0003-4863-9965.

Case Presentation

A 10-year-old female patient, phototype V, short stature, had 

a lesion in the occipital region with a 6-month progression. 

It started as a red papule, measuring 0.5 cm, with stability 

for three months. During this period, the child started sub-

cutaneous somatotropin for short stature, coinciding with 

significant lesion growth. On dermatological examination, 

a nodular multilobulated lesion with firm consistency and 

pink-to-red tones was observed, measuring approximately  

2 centimeters (Figure 1A). Dermoscopy revealed shiny white 

structures, atypical vessels, reddish and pinkish areas, and 

remnants of grayish pigment (Figures 1B and 1C).

Histopathological findings showed a compound me-

lanocytic nevus with a predominance of fusiform cells 

 (Figure 1D). Immunohistochemical study revealed positivity 

for S100, SOX10, p16, and Ki67 and negativity for HMB45, 

CD31, CD34, CD57, and Tyrosinase (Figure 1E), findings 

consistent with a compound Spitz nevus (SN).

Teaching Points

SN is a rare melanocytic neoplasm of fusiform cells which 

typically appears in childhood. Dermoscopically, SN are typ-

ified by three main patterns: starburst, regularly distributed 

dotted vessels, and globular with reticular depigmentation. 

Nodular lesions should be excised or closely monitored [1].  

There is limited scientific evidence linking melanocytic ne-

vus increase with the use of growth hormone. However, 

there is a possibility that preexisting melanocytic nevi may 

be stimulated by exogenous somatotropin, leading to lesion 

growth [2]. 

This case represents an atypical presentation of SN, char-

acterized by a multilobulated morphology distinct from the 



2 Image Letter | Dermatol Pract Concept. 2025;15(3):5464

and management guidelines by the International Dermoscopy 

Society. Br J Dermatol. 2017 Sep;177(3):645-655. DOI: 10.1111 

/bjd.15339. Epub 2017 Jul 19. PMID: 28118479.

2. Piérard GE, Piérard-Franchimont C, Nikkels A, Nikkels- 

Tassoudji N, Arrese JE, Bourguignon JP. Naevocyte triggering 

by recombinant human growth hormone. J Pathol. 1996;180(1): 

74-79. DOI:10.1002/(SICI)1096-9896(199609)180:1<74::AID-

PATH595>3.0.CO;2-A.

previously described polypoid lesions and an unusually rapid 

growth rate potentially associated with somatotropin use.

References

1. Lallas A, Apalla Z, Ioannides D, Lazaridou E, Kyrgidis A, 

 Broganelli P, Alfano R, Zalaudek I, Argenziano G; International 

Dermoscopy Society. Update on dermoscopy of Spitz/Reed naevi 

Figure 1. (A) Multilobulated, firm, pink-to-red nodular lesion located in the occipital region.  

(B, C) Dermoscopic examination reveals shiny white structures, atypical vessels, pinkish to reddish 

areas, and remnants of grayish pigment. (D) Histopathology demonstrates a compound melanocytic 

nevus with a predominance of fusiform cells. (E) Immunohistochemical staining shows positivity 

for S100.