Derm Dx: Nasal lesion with starburst pattern on dermoscopy - Clinical Advisor

Derm Dx: Nasal lesion with starburst pattern on dermoscopy

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A 3-year-old male presents for evaluation of a lesion on his nose that was first noted approximately 6 months ago and has been enlarging in size. The site bleeds when traumatized but not spontaneously. He is of normal development and mentation. Family history is negative for genodermatoses. Examination reveals a 0.3-cm erythematous papule. Dermoscopy demonstrates a starburst pattern. No other lesions are apparent elsewhere.

The Spitz nevus is a rarely encountered benign melanocytic proliferation that often presents as a solitary, rapidly enlarging erythematous papule most commonly located on the face or extremities of children and adolescents. They most often feature symmetry, smooth surface, and...

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The Spitz nevus is a rarely encountered benign melanocytic proliferation that often presents as a solitary, rapidly enlarging erythematous papule most commonly located on the face or extremities of children and adolescents. They most often feature symmetry, smooth surface, and well-demarcated borders.1 Both sexes are equally affected. 

The lesion was first described in 1948 by Sophie Spitz and bears her name.2 Because histopathology of the Spitz nevus may resemble that of melanoma she referred to these nevi as ‘juvenile melanomas.’ A few years later, she co-authored a paper stressing that the majority of these lesions are indeed benign.3

Differentiation from melanoma is most problematic when lesions are hyperpigmented and arise in older individuals.4 Diagnostic accuracy is greatly enhanced by dermoscopy5; the most common presentation is that of a starburst pattern manifesting multiple pigmented striations and/or large brown or black globules distributed symmetrically along the margins of the lesion, with a radiated appearance.5


Once diagnosed by biopsy, most dermatologists recommend conservative management of Spitz nevi.6 However, lesions with atypical clinical, dermatoscopic, and/or histopathologic findings are best managed by wide excision.

Megha D. Patel is a student at the Commonwealth Medical College, Scranton, Pennsylvania.

Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College and an adjunct assistant professor of dermatology at the University of Pennsylvania Medical College. He practices dermatology in Hazleton, Pennsylvania.

References

  1. Piepkorn M. On the nature of histologic observations: The case of the Spitz nevus. J Am Acad Dermatol. 1995;32(2 Pt 1):248-254.
  2. Spitz S. Melanomas of childhood. Am J Pathol. 1948;24(3):591-609.
  3. Allen AC, Spitz S. Malignant melanoma; a clinicopathological analysis of the criteria for diagnosis and prognosis. Cancer. 1953;6(1):1-45.
  4. Dal Pozzo V, Benelli C, Restano L, Gianotti R, Cesana BM. Clinical review of 247 case records of Spitz nevus (epithelioid cell and/or spindle cell nevus). Dermatology. 1997;194(1):20-25.
  5. Argenziano G, Scalvenzi M, Staibano S, et al. Dermatoscopic pitfalls in differentiating pigmented Spitz naevi from cutaneous melanomas. Br J Dermatol. 1999;141(5):788-793.
  6. Gelbard SN, Tripp JM, Marghoob AA, et al. Management of Spitz nevi: A survey of dermatologists in the United States. J Am Acad Dermatol. 2002;47(2):224-230.
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