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SKINDIA QUIZ |
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Year : 2019 | Volume
: 10
| Issue : 4 | Page : 488-489 |
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SkIndia Quiz 52: A verrucous growth over elbow of a young child
Ranjana Beniwal, Asit Mittal, Khushboo Gupta, Manisha Balai
Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India
Date of Web Publication | 28-Jun-2019 |
Correspondence Address: Asit Mittal Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur -313 001, Rajasthan India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2229-5178.258581
How to cite this article: Beniwal R, Mittal A, Gupta K, Balai M. SkIndia Quiz 52: A verrucous growth over elbow of a young child. Indian Dermatol Online J 2019;10:488-9 |
How to cite this URL: Beniwal R, Mittal A, Gupta K, Balai M. SkIndia Quiz 52: A verrucous growth over elbow of a young child. Indian Dermatol Online J [serial online] 2019 [cited 2021 Jan 27];10:488-9. Available from: https://www.idoj.in/text.asp?2019/10/4/488/258581 |
A 6-year-old male child presented to us with a single, asymptomatic, verrucous lesion over right elbow since 6 months. The lesion was initially small and slowly progressed with time to attain the present dimensions. Apart from a history of occasional bleeding after minor trauma, there were no other complaints. Physical examination revealed a solitary, slightly scaly, erythematous, verrucous nodule of about 1 × 1 × 1 cm in size over right elbow. The nodule was firm in consistency on palpation and did not elicit any tenderness [Figure 1]. The child was in good general health. A biopsy was taken from the lesion.
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What is your diagnosis?
Histology showed moderate epidermal hyperplasia with focal hypergranulosis [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d. Several vertically oriented small and medium sized nests of epithelioid melanocytes were seen at dermo-epidermal junction. The entire dermis was infiltrated by nests and small cords of spindled and epithelioid melanocytes with a sparse to moderately dense lymphocytic infiltrate. Immunohistochemistry showed positivity for S100 and Melan A [Figure 3]a and [Figure 3]b. | Figure 2: (a-d) Histology showing vertically oriented nests of spindled and epithelioid melanocytes in the dermis (H and E stain ×2.5, ×5, ×10, and ×20)
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 | Figure 3: (a and b) Immunohistochemistry showing S100 (×10) and Melan A positivity (×10)
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View Answer
[TAG:2]Answer[/TAG:2] Spitz nevus. [TAG:2]Discussion[/TAG:2] Spitz nevus is a benign melanocytic lesion, first described by Sophie Spitz in 1948 as “juvenile melanoma.” [1] It occurs most often in children or young adults but can occur at any age. [2] It commonly appears as a solitary, dome shaped, firm, red, or brown nodule, [3] mainly affecting the face and extremities. [1] Spitz nevi are generally asymptomatic, but growth can occur over a period of months. The lesions can uncommonly bleed, itch, or be painful. [2] Differential diagnosis includes melanoma, pyogenic granuloma, verrucae, juvenile xanthogranuloma, dermatofibroma, and hemangioma. [2]The hallmark of the pathology of Spitz nevus is the presence of large or spindle melanocytes, usually arranged in nests. The nests are composed of an admixture of spindle and epithelioid cells. Kamino bodies are pale eosinophilic globules, which are commonly found at the dermal-epidermal junction. [2]Complete excision with margins free of tumor is the treatment of choice for all Spitz nevi. Spitz nevi with typical features on presentation and biopsy usually are associated with a favorable prognosis, [4] but it is advisable that patients with atypical lesions have periodic evaluations every 6 to 12 months. Declaration of patient consentThe authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorshipNil. Conflicts of interestThere are no conflicts of interest.
References | |  |
1. | Yoradjian A, Enokihara MM, Paschoal FM. Spitz nevus and Reed nevus. An Bras Dermatol 2012;87:349-59. |
2. | Lyon VB. The spitz nevus: Review and update. Clin Plast Surg 2010;37:21-33. |
3. | Chen J, Kong QT, Zhang M, Sang H. Recurrent Spitz nevus with multiple satellite lesions on perineum. Indian J Dermatol Venereol Leprol 2015;81:96.  [ PUBMED] [Full text] |
4. | Honda R, Iino Y, Ito S, Tanaka M. Verrucous spitz nevus in a Japanese female. Case Rep Dermatol 2013;5:304-8. |
[Figure 1], [Figure 2], [Figure 3]
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