Letter - Clinical
Acral reed nevus with parallel ridge pattern: an exception to the rule of malignancy
a Department of Dermatology, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, Lleida, Spain
b Department of Pathology, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, Lleida, Spain
c Centre of Biomedical Research on Cancer, Instituto de Salud Carlos III, Madrid, Spain
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(A) Características clínicas da lesão. (B) Achados dermatoscópicos mostrando padrão de cristas paralelas com algumas estrias periféricas. (C) Os achados histopatológicos consistiam em ninhos de células tumorais dispersos na epiderme (Hematoxilina & eosina, 100<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>). (D) Os ninhos juncionais eram compostos de melanócitos fusiformes muito pigmentados, orientados verticalmente (Hematoxilina & eosina, 200<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elena Canal‐Garcia, Xavier Soria, Felip Vilardell, Rosa M. Marti" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Elena" "apellidos" => "Canal‐Garcia" ] 1 => array:2 [ "nombre" => "Xavier" "apellidos" => "Soria" ] 2 => array:2 [ "nombre" => "Felip" "apellidos" => "Vilardell" ] 3 => array:2 [ "nombre" => "Rosa M." 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Marti" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Elena" "apellidos" => "Canal-Garcia" "email" => array:1 [ 0 => "ecanal.germanstrias@gencat.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Xavier" "apellidos" => "Soria" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Felip" "apellidos" => "Vilardell" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Rosa M." "apellidos" => "Marti" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Dermatology, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, Lleida, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pathology, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, Lleida, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centre of Biomedical Research on Cancer, Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "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" => 2925 "Ancho" => 2925 "Tamanyo" => 1252839 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Reed nevus on the finger (A) Clinical features of the lesion. (B) Dermoscopic findings show a parallel ridge pattern with some peripheral streaks. (C) Histopathological findings were tumor cell nests scattered within the epidermis (Hematoxylin & eosin, ×100). (D) Junctional nests were composed of heavily pigmented spindle-shaped melanocytes, vertically oriented (Hematoxylin & eosin, ×200).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Reed nevi (RNs) are almost exclusively junctional neoplasms distinguished as a variant of Spitz nevus (SN) by their significant melanogenesis and growth pattern. Acral presentation of SN is rare and has specific clinical and histopathological features.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Nonetheless, dermoscopic findings of SN and its variants on the acral skin are poorly documented.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Herein we describe a case of RN on the volar skin of a finger in which parallel ridge pattern was observed by dermoscopic examination.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 9-year-old boy presented with an asymptomatic pigmented lesion on his right hand. He had detected the lesion 8 months previously and had enlarged gradually. He had no personal or family history of malignant tumors. Physical examination revealed an asymmetrical dark brown macule, 13×3 mm in size, located on the volar region of the second right finger. The lesion exhibited an atypical linear morphology similar to a crescent moon (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Dermoscopic findings showed a brownish parallel ridge pattern with some streaks at the periphery (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). A complete surgical excision was done to rule out malignancy. Histological examination revealed several small nests, vertically oriented, composed of heavily pigmented spindled melanocytes along the dermo-epidermal junction (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C‒D). No melanocytes were seen in the dermis. A diagnosis by an RN was done.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Acral SNs understood by those located on soles, palms and fingers are infrequent, being reported to comprise less than 2% of all SNs.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> They are more common in young female adults, more frequently located on the feet, and larger than acral melanocytic nevi.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Acral RN or “pigmented spindle-cell nevus” is the most common variant of SN that typically presents as a heavily pigmented lesion.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Given the overlapping clinicopathologic features with malignancy, their clinical diagnosis is often of an atypical nevus or a malignant melanoma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Dermoscopic examination is useful in differentiating RN and acral lentiginous malignant melanoma.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Dermoscopic patterns most commonly associated with SN are starburst and globular patterns.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However, a characteristic pattern upon dermoscopic examination of SN localized on the glabrous skin has not been described.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> A review of the literature revealed only nine cases of acral SN and its variants with the dermoscopic examination.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> A parallel furrow pattern with peripheral dots, streaks, and projections and a starburst pattern has been reported in four and three cases, respectively.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> A crista-dotted pattern was described in one case of SN on the palm.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Only Jurakić et al. in 2018 reported a young female with a rapidly growing plantar pigmented SN that had a dermoscopic parallel ridge pattern with few peripheral globules, similar to our case.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion, we report a case of an acral RN showing a parallel ridge pattern on dermoscopy, an exception to the rule of malignancy. The present report aims to highlight that, although such a pattern is highly suggestive of melanoma, it can also be seen in a proportion of acral SNs localized on the glabrous skin. However, an SN with asymmetry and/or atypical dermoscopic pattern is impossible to differentiate from melanoma and, thereby, must be excised irrespective of age or clinical morphology.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0025" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0030" class="elsevierStylePara elsevierViewall">Elena Canal-Garcia: Study concept and design; drafting and editing of the manuscript; writing of the manuscript or critical review of important intellectual content; data collection, analysis and interpretation; effective participation in the research guidance; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; final approval of the final version of the manuscript.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Xavier Soria: Study concept and design; drafting and editing of the manuscript; writing of the manuscript or critical review of important intellectual content; data collection, analysis and interpretation; effective participation in the research guidance; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; final approval of the final version of the manuscript.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Felip Vilardell: Writing of the manuscript or critical review of important intellectual content; data collection, analysis and interpretation; effective participation in the research guidance; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; final approval of the final version of the manuscript.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Rosa M. Martí: Study concept and design; drafting and editing of the manuscript; writing of the manuscript or critical review of important intellectual content; data collection, analysis and interpretation; effective participation in the research guidance; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; final approval of the final version of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-02-05" "fechaAceptado" => "2021-05-01" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Department of Dermatology, Arnau de Vilanova University Hospital, Lleida, Spain.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2925 "Ancho" => 2925 "Tamanyo" => 1252839 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Reed nevus on the finger (A) Clinical features of the lesion. (B) Dermoscopic findings show a parallel ridge pattern with some peripheral streaks. (C) Histopathological findings were tumor cell nests scattered within the epidermis (Hematoxylin & eosin, ×100). (D) Junctional nests were composed of heavily pigmented spindle-shaped melanocytes, vertically oriented (Hematoxylin & eosin, ×200).</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.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 26 | 9 | 35 |
| 2024 October | 125 | 80 | 205 |
| 2024 September | 152 | 103 | 255 |
| 2024 August | 188 | 115 | 303 |
| 2024 July | 169 | 117 | 286 |
| 2024 June | 115 | 91 | 206 |
| 2024 May | 91 | 57 | 148 |
| 2024 April | 106 | 90 | 196 |
| 2024 March | 120 | 83 | 203 |
| 2024 February | 87 | 71 | 158 |
| 2024 January | 72 | 56 | 128 |
| 2023 December | 62 | 61 | 123 |
| 2023 November | 85 | 89 | 174 |
| 2023 October | 77 | 96 | 173 |
| 2023 September | 90 | 75 | 165 |
| 2023 August | 66 | 32 | 98 |
| 2023 July | 95 | 28 | 123 |
| 2023 June | 73 | 58 | 131 |
| 2023 May | 67 | 25 | 92 |
| 2023 April | 105 | 56 | 161 |
| 2023 March | 105 | 66 | 171 |
| 2023 February | 105 | 53 | 158 |
| 2023 January | 35 | 42 | 77 |
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