Case Report
Recurrence of melanoma in the scar after excised Spitz nevus in a 17-year-old child
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Melanoma nodular, do tipo epitelioide, Clark 3, Breslow 2,39<span class="elsevierStyleHsp" style=""></span>mm. As setas indicam as mitoses atípicas no tumor. 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(B) and (C) Dyskeratotic cells are well seen (Hematoxylin & eosin, ×400).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Tauana Ogata Coelho da Rocha, Fernanda Gonçalves Moya, Vívian Moreira Vilella, Rute Facchini Lellis" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Tauana Ogata Coelho da" "apellidos" => "Rocha" ] 1 => array:2 [ "nombre" => "Fernanda Gonçalves" "apellidos" => "Moya" ] 2 => array:2 [ "nombre" => "Vívian Moreira" "apellidos" => "Vilella" ] 3 => array:2 [ "nombre" => "Rute Facchini" "apellidos" => "Lellis" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275221001168" "doi" => "10.1016/j.abdp.2020.12.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275221001168?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962100115X?idApp=UINPBA00008Z" "url" => "/03650596/0000009600000004/v4_202107160617/S036505962100115X/v4_202107160617/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0365059621001045" "issn" => "03650596" "doi" => "10.1016/j.abd.2020.08.016" "estado" => "S300" "fechaPublicacion" => "2021-07-01" "aid" => "364" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Interstitial lung disease due to anti-TNF use in the treatment of psoriasis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "447" "paginaFinal" => "450" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3239 "Ancho" => 3333 "Tamanyo" => 988133 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bilateral pulmonary infiltration characterized by ground-glass opacities and fine reticulation with a basal predominance. 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Caption: Nodular melanoma, epithelioid type, Clark 3, Breslow 2.39-mm. (A), Hematoxylin & eosin ×40, (B), Hematoxylin & eosin ×100. The arrows indicate the pathological mitoses in the tumor.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Spitz nevi are benign tumors usually arising during childhood as rapidly growing non-pigmented -pink or red papules or nodules most often of the lower extremities or on the face.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The authors report the case of a 17-year-old boy who was first diagnosed with spitz nevus, but the final diagnosis made after the re-excision of the scar was changed to melanoma.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 17-year-old boy presented to the Specialist Medical Practice in Tychy, Poland, with a tumor increasing in the scar on the left thigh six months after surgical excision of a nevus in this site. The excised, pink 5-mm rapidly growing tumor had been subjected to histopathological examination and Spitz nevus had been diagnosed. The patient denied preceding trauma and a family history of melanoma. There had been no dermoscopy before the surgical procedure.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Clinical examination of the red scar revealed the presence of the shining nodule in its lower segment. In dermoscopy, the polymorphic pattern was present with a predominance of linear irregular vessels (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Considering dermoscopic features and the diagnosis of Spitz nevus, the patient underwent subsequent excision of the scar and histopathological diagnosis of recurrent Spitz nevus was established.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In the 3-month dermoscopic follow-up of the scar, the polymorphous vascular pattern consisting of dotted and linear vessels was present. Moreover, in the lower segment of the scar, there was a pinkish structure so-called the “milky red area” (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Because of discordance between the previous diagnosis and the alarming dermoscopic image, the patient underwent subsequent surgical excision of the scar. Based on the clinical and histopathological features a diagnosis of nodular melanoma, epithelioid type, Clark 3, Breslow 2.39-mm was established (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The diagnosis was confirmed by immunohistochemistry-MelanA(+), Ki67 positive in 10% of all malignant cells. Sentinel lymph node biopsy showed metastasis.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">The distinction of melanoma even from a clinically typical Spitz nevus is still challenging, mainly because their dermoscopic and even histopathological features can overlap. The lower extremities are the most common anatomic region for both Spitz nevi and Spitzoid melanomas.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The studied patient’s young age and negative family history raised the suspicion of Spitz nevus, however, the evolution of the scar, especially after the second excision was highly dubious, because the Spitz nevi have a low recurrence rate, even after incomplete excision.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Moreover, its dermoscopic features, particularly the dotted and linear vessels, greatly increased the likelihood of the lesion being a melanoma. Unfortunately, the dermoscopic image of the primary lesion of the patient in this present study patient is not known because this diagnostic procedure was missed before surgical excision.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The histopathological examination still remains as the gold standard for Spitz nevus diagnosis although in some cases, even with the use of immunohistochemical markers, an entirely safe diagnosis cannot be made.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Although rare, the incidence of pediatric melanomas has been increasing, and most of them arise de novo rather than in preexisting nevi.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Moreover, most of the pediatric melanomas are located at the lower extremities, with delayed diagnosis resulting in thick lesions and more likely with positive sentinel nodes.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">This case highlighted that the pink, rapidly growing nodular lesions in a patient older than 12-years of age should be excised but with a mandatory preceding dermoscopy.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors’ contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Joanna Pogorzelska-Dyrbuś: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Beata Bergler-Czop: Approval of the final version of the manuscript; design and planning of the study; critical review of the literature; critical review of the manuscript.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Maciej Kajor: Approval of the final version of the manuscript; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1550365" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1400152" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Financial support" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Authors’ contributions" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-03-02" "fechaAceptado" => "2020-07-16" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1400152" "palabras" => array:3 [ 0 => "Melanoma" 1 => "Nevus, epithelioid and spindle cell" 2 => "Recurrence" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Melanoma in childhood is rare and its diagnosis is more difficult than in adults, as it often presents histologic features overlapping with the Spitz nevus. The authors report the case of a 17-year old boy who was first diagnosed with Spitz nevus, however, the final diagnosis made after the excision of the tumor arising in the scar was changed to melanoma. The case in this present study emphasizes the importance of the differential diagnosis of skin tumors in young patients.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Pogorzelska-Dyrbuś J, Bergler-Czop B, Kajor M. Recurrence of melanoma in the scar after excised Spitz nevus in a 17-year-old child. An Bras Dermatol. 2021;96:451–3.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Medical University of Silesia, Katowice, Poland.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 716 "Ancho" => 905 "Tamanyo" => 133388 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The dermoscopic image of the first scar. The polymorphic pattern with a predominance of linear irregular vessels was visible.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 511 "Ancho" => 905 "Tamanyo" => 83925 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The dermoscopic image of the second scar. The polymorphous vascular pattern consisted of dotted and linear vessels along with a “milky red area”.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1353 "Ancho" => 905 "Tamanyo" => 329163 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathological image of the melanoma. Caption: Nodular melanoma, epithelioid type, Clark 3, Breslow 2.39-mm. (A), Hematoxylin & eosin ×40, (B), Hematoxylin & eosin ×100. The arrows indicate the pathological mitoses in the tumor.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spitz nevus: a clinicopathological study of 349 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Requena" 1 => "L. Requena" 2 => "H. Kutzner" 3 => "E. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 7 | 19 |
| 2024 October | 111 | 73 | 184 |
| 2024 September | 153 | 81 | 234 |
| 2024 August | 162 | 119 | 281 |
| 2024 July | 170 | 100 | 270 |
| 2024 June | 131 | 74 | 205 |
| 2024 May | 167 | 73 | 240 |
| 2024 April | 138 | 81 | 219 |
| 2024 March | 96 | 74 | 170 |
| 2024 February | 88 | 70 | 158 |
| 2024 January | 68 | 58 | 126 |
| 2023 December | 43 | 55 | 98 |
| 2023 November | 70 | 75 | 145 |
| 2023 October | 68 | 73 | 141 |
| 2023 September | 60 | 87 | 147 |
| 2023 August | 62 | 34 | 96 |
| 2023 July | 64 | 27 | 91 |
| 2023 June | 66 | 42 | 108 |
| 2023 May | 71 | 24 | 95 |
| 2023 April | 39 | 16 | 55 |
| 2023 March | 71 | 44 | 115 |
| 2023 February | 52 | 36 | 88 |
| 2023 January | 42 | 46 | 88 |
| 2022 December | 49 | 43 | 92 |
| 2022 November | 76 | 56 | 132 |
| 2022 October | 93 | 56 | 149 |
| 2022 September | 48 | 66 | 114 |
| 2022 August | 41 | 48 | 89 |
| 2022 July | 40 | 55 | 95 |
| 2022 June | 40 | 64 | 104 |
| 2022 May | 48 | 63 | 111 |
| 2022 April | 45 | 50 | 95 |
| 2022 March | 56 | 70 | 126 |
| 2022 February | 35 | 50 | 85 |
| 2022 January | 58 | 105 | 163 |
| 2021 December | 54 | 80 | 134 |
| 2021 November | 48 | 83 | 131 |
| 2021 October | 66 | 102 | 168 |
| 2021 September | 73 | 86 | 159 |
| 2021 August | 103 | 99 | 202 |
| 2021 July | 123 | 67 | 190 |
| 2021 June | 51 | 64 | 115 |
| 2021 May | 13 | 19 | 32 |
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