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Case Report
Atypical Spitz nevus versus Spitz melanoma: Is age a deceiving factor?
1 Department of Pathology and Molecular Medicine, Hamilton Regional Lab Medicine Program, McMaster University, Hamilton, ON, Canada
2 Division of Pediatric Surgery, Department of Surgery, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
3 Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Center, Hamilton, ON, Canada
Address correspondence to:
Charles Jian
1280 Main Street West, Hamilton, ON L8S 4L8,
Canada
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Article ID: 100039Z11CJ2020
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How to cite this article
Jian C, Salama S, Gohla G, Mohamed S, Cameron BH, Heller B, Alowami S. Atypical Spitz nevus versus Spitz melanoma: Is age a deceiving factor? J Case Rep Images Pathol 2020;6:100039Z11CJ2020.ABSTRACT
Introduction: Spitz melanoma is very rare in the young pediatric (0–10) population, with clinical behavior differing from adult melanoma. It may be challenging to distinguish diagnostically from an atypical Spitz nevus, and patients’ young age may cause hesitation despite histological support.
Case Report: We present a case report of pediatric-type Spitz melanoma in a 4-years-8-months-old girl which was reviewed by pathology groups from 1 tertiary and 2 quaternary centers. A diagnosis was made only after extensive genetic testing in conjunction with the supporting evidence from histology and immunohistochemistry. 19 previously published case reports of pediatric-type Spitz melanoma are also reviewed and summarized to give insight into its presentation and prognosis.
Conclusion: This case report and review of literature highlights that age can be a misleading factor in reporting atypical melanocytic lesions, and may deter pathologists from diagnosing a tumor as malignant. While clinical history is indispensable in pathology practice, the patient’s age should not distract us from the histology. It also demonstrates the usefulness of molecular pathology as a future adjunct in the practice of pathology. Entities that overlap morphologically or that present with conflicting histological features may be more easily categorized based on the presence of genetic variants or deletions. In our case, p16 deletion and anaplastic lymphoma kinase (ALK) translocation were supporting features that in conjunction with histology clinched the diagnosis of melanoma.
Keywords: Age, Atypical Spitz nevus, Molecular pathology, Pediatric, Spitz melanoma
SUPPORTING INFORMATION
Author Contributions
Charles Jian - Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Samih Salama - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Gabriela Gohla - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Sarab Mohamed - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Brian H Cameron - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Barbara Heller - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Salem Alowami - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Charles Jian et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
