Case 40 Male, 59 years. Bluish, smooth-surfaced papule, skin of backShow diagnosis & comments
Spitzoid superficial spreading melanoma (with small naevus remnant)
There is a resemblance to Spitz naevus, but a number of findings points to malignancy: epidermal flattening and thinning, with collarette; compact architecture of dermal cell groups, cellular atypia (most prononouced in superficial part); dermal mitotic activity in all levels. Arguably, this lesion could be regarded as STUMP, but in conjunction with the patient's age, it was fet that these features were sufficient to diagnose (spitzoid) melanoma.
- Since Spitz naevus resembles melanoma more closely than other naevus types (Sophie Spitz originally considered them to be melanomas that, for some reason, did not manifest their malignant potential in children), it follows that melanomas not uncommonly resemble Spitz naevus. If the resemblance is striking, such melanomas are sometimes referred to as 'spitzoid melanomas'.
- Since this resemblance is independent of other parameters that allow subtyping of melanoma, there are spitzoid superficial spreading melanomas, spitzoid nodular melanomas, etc.
- The spitzoid appearance does not have a bearing on the melanoma in terms of clinical behaviour.