A Case of Spitz Nevus with Setting Sun Dermoscopic Pattern.

Sir,

A 24-year-old man presented with a 1-month history of an asymptomatic pink dome-shaped papule on the right cheek [Figure 1]. The papule enlarged gradually without any treatment. The patient was otherwise healthy, with unremarkable medical history and with no history of trauma. The dermoscopic examination (polarized light, original magnification 50×) revealed irregular bright red areas, light yellow areas and linear vessels with a pink background [Figure 2]. Histopathologic examination showed parakeratosis, acanthosis and a well-defined, wedge-shaped dermal tumour composed of eosinophilic spindle cells with lymphocytic infiltration, oedematous upper dermis and superficial telangiectatic vessels [Figure 3]. The nuclei of spindle cells were vesicular, uniform and contained small nucleoli, and mitotic figure was found [Figure 4]. A diagnosis of Spitz nevus was made. After surgery, there was no local recurrence at 1-year follow-up.

Figure 1

A pink dome-shaped papule on the right cheek

Figure 2

Dermoscopy showed multiple irregular bright red areas, light yellow areas and linear vessels with a pink background

Figure 3

Parakeratosis, acanthosis and a well-defined, wedge-shaped dermal tumour composed of eosinophilic spindle cells with oedematous upper dermis and superficial telangiectatic vessels (Haematoxylin and eosin, 100×)

Figure 4

The nuclei of spindle cells were vesicular, uniform and contained small nucleoli, and mitotic figure was found (Haematoxylin and eosin, 600×)

Spitz nevi are uncommon melanocytic neoplasms, usually occurring in children, with some presenting at birth. Spitz nevi can occasionally be confused with melanoma. Most Spitz nevi present as asymptomatic, solitary, dome-shaped nodules or papules, with pink, red, brown or black coloration depending on the melanin content. While Spitz nevi may develop anywhere on the body, they are frequently observed on the lower extremities as well as in the head and neck.[1] Histologically, although compound lesions predominate, both junctional and intradermal variants may also be encountered in Spitz nevi. The typical tumour, composed of spindled cells and/or epithelioid cells, is dome-shaped and often has a wedge-shaped outline with sharp circumscription and symmetry. Other histopathological findings include maturation, inflammatory infiltrate, epidermal hyperplasia, presence of melanin, telangiectasias, Kamino bodies, desmoplastic stroma, mitosis, pagetoid spread and hyalinisation.[1]

In dermoscopy, non-pigmented Spitz nevi exhibit five features, including homogenous pink colour, dotted vascular pattern, starburst vascular pattern, reticular depigmentation and chrysalis structures, whereas pigmented Spitz nevi exhibit globular pattern, starburst pattern, homogenous pattern or multi-component pattern.[2] The dermoscopic image of our patient resembled a setting sun appearance. The setting sun dermoscopic pattern was first reported in juvenile xanthogranuloma.[3] Subsequently, it was believed that the setting sun dermoscopic pattern is a characteristic dermoscopic feature of several skin lesions, including Spitz nevi, sebaceous hyperplasia, reticulohistiocytoma, mastocytosis and xanthomatous dermatofibroma.[4] Therefore, careful interpretation depending on the clinical, histopathologic and immunochemical manifestations is warranted.

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The 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.

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Conflicts of interest

There are no conflicts of interest.