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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Spitz nevus is a benign melanocytic lesion with peculiar clinical&#44; dermoscopic and histopathological features&#44; which are often confused with those of melanoma&#44; making its diagnosis a challenge&#46; While melanocytic nevi are relatively common on the palmoplantar region&#44; Spitz nevus rarely affects this site&#44; with few reports in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This case report describes a 20-year-old female patient&#44; phototype III&#44; with a complaint of a &#34;spot&#34; on the plantar surface for years&#44; with recent growth&#46; On the left plantar region&#44; she had a blackened macula measuring 0&#46;5&#8239;cm&#44; with precise limits and irregular edges &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Dermoscopy showed a melanocytic lesion with a whitish blue veil in the center and peripheral brownish homogeneous areas&#44; with a fibrillar pattern at one o&#39;clock position &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; An excisional biopsy was performed&#44; with hypotheses of blue nevus and acrolentiginous melanoma&#46; The anatomopathological examination revealed a compound fusocellular-epithelioid melanocytic nevus compatible with a Spitz nevus &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">According to a publication by Wiedemeyer et al&#46; in 2018&#44; acral Spitz nevus has a predilection for the plantar region of young female adults&#44; a finding consistent with the present case&#46; Moreover&#44; it was observed that the acral variant is predominantly pigmented&#44; with irregular borders and a larger size than conventional acral nevi&#46; Such characteristics raise suspicion for malignancy&#44; including atypical nevus and melanoma in the differential diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Dermoscopy is a valuable tool in the clinical diagnosis of pigmented lesions&#46; Basically&#44; in the case of acral melanocytic lesions&#44; the parallel ridge pattern or diffuse&#44; irregular pigmentation is highly suggestive of melanoma&#59; the parallel furrow pattern prevails in benign melanocytic nevi&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Regarding acral Spitz nevus&#44; however&#44; it is possible to find varied patterns with more than one component&#44; and the lack of specific findings makes it difficult to exclude malignancy&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In parallel&#44; the confocal reflectance microscopy &#40;CRM&#41; is a non-invasive imaging test that has helped to differentiate between benign nevi and melanomas&#46; However&#44; its use is limited in the investigation of acral lesions due to the palmoplantar stratum corneum thickness&#44; which makes observation of deeper structures difficult&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Histopathologically&#44; the classic Spitz nevus presents large&#44; spindle-shaped&#44; and&#47;or epithelioid melanocytes&#44; with abundant eosinophilic cytoplasm&#44; vesicular nucleus and small nucleolus&#46; In acral Spitz nevus&#44; which can be junctional or compound&#44; a combination of spitzoid cytomorphology with the atypical junctional growth pattern of acral nevi is observed&#46; It is also possible to find junctional nests with irregular distribution and shapes&#44; pagetoid spread&#44; and transepidermal elimination of melanocytic nests&#44; findings that mimic the histopathological pattern of acrolentiginous melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In dubious cases&#44; the correct diagnosis can be aided by immunohistochemistry&#58; Spitz nevi&#44; with rare exceptions&#44; express large amounts of P16 and P21 markers&#59; conversely&#44; acrolentiginous melanomas show significant loss of these markers&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Therefore&#44; while there are no studies that clarify the role of dermoscopy and CRM in differentiating between acral Spitz nevus and acrolentiginous melanoma&#44; the excisional biopsy and histopathological study remain the diagnostic pillars for atypical acral pigmented lesions&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Guilherme Camargo Julio Valinoto&#58; Drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Felipe Henrique Yazawa Santos&#58; Drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Rute Facchini Lellis&#58; Design and planning of the study&#59; collection&#44; analysis&#44; and interpretation of data&#59; effective participation in research orientation&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Marcus Maia&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Case Letter
Plantar Spitz nevus mimicking melanoma
Guilherme Camargo Julio Valinotoa,
Autor para correspondência
guivalinoto@gmail.com

Corresponding author.
, Felipe Henrique Yazawa Santosa, Rute Facchini Lellisb, Marcus Maiaa
a Dermatology Clinic, Santa Casa of São Paulo Hospital, São Paulo, SP, Brazil
b Laboratory of Pathology, Santa Casa of São Paulo Hospital, São Paulo, SP, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Spitz nevus is a benign melanocytic lesion with peculiar clinical&#44; dermoscopic and histopathological features&#44; which are often confused with those of melanoma&#44; making its diagnosis a challenge&#46; While melanocytic nevi are relatively common on the palmoplantar region&#44; Spitz nevus rarely affects this site&#44; with few reports in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This case report describes a 20-year-old female patient&#44; phototype III&#44; with a complaint of a &#34;spot&#34; on the plantar surface for years&#44; with recent growth&#46; On the left plantar region&#44; she had a blackened macula measuring 0&#46;5&#8239;cm&#44; with precise limits and irregular edges &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Dermoscopy showed a melanocytic lesion with a whitish blue veil in the center and peripheral brownish homogeneous areas&#44; with a fibrillar pattern at one o&#39;clock position &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; An excisional biopsy was performed&#44; with hypotheses of blue nevus and acrolentiginous melanoma&#46; The anatomopathological examination revealed a compound fusocellular-epithelioid melanocytic nevus compatible with a Spitz nevus &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">According to a publication by Wiedemeyer et al&#46; in 2018&#44; acral Spitz nevus has a predilection for the plantar region of young female adults&#44; a finding consistent with the present case&#46; Moreover&#44; it was observed that the acral variant is predominantly pigmented&#44; with irregular borders and a larger size than conventional acral nevi&#46; Such characteristics raise suspicion for malignancy&#44; including atypical nevus and melanoma in the differential diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Dermoscopy is a valuable tool in the clinical diagnosis of pigmented lesions&#46; Basically&#44; in the case of acral melanocytic lesions&#44; the parallel ridge pattern or diffuse&#44; irregular pigmentation is highly suggestive of melanoma&#59; the parallel furrow pattern prevails in benign melanocytic nevi&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Regarding acral Spitz nevus&#44; however&#44; it is possible to find varied patterns with more than one component&#44; and the lack of specific findings makes it difficult to exclude malignancy&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In parallel&#44; the confocal reflectance microscopy &#40;CRM&#41; is a non-invasive imaging test that has helped to differentiate between benign nevi and melanomas&#46; However&#44; its use is limited in the investigation of acral lesions due to the palmoplantar stratum corneum thickness&#44; which makes observation of deeper structures difficult&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Histopathologically&#44; the classic Spitz nevus presents large&#44; spindle-shaped&#44; and&#47;or epithelioid melanocytes&#44; with abundant eosinophilic cytoplasm&#44; vesicular nucleus and small nucleolus&#46; In acral Spitz nevus&#44; which can be junctional or compound&#44; a combination of spitzoid cytomorphology with the atypical junctional growth pattern of acral nevi is observed&#46; It is also possible to find junctional nests with irregular distribution and shapes&#44; pagetoid spread&#44; and transepidermal elimination of melanocytic nests&#44; findings that mimic the histopathological pattern of acrolentiginous melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In dubious cases&#44; the correct diagnosis can be aided by immunohistochemistry&#58; Spitz nevi&#44; with rare exceptions&#44; express large amounts of P16 and P21 markers&#59; conversely&#44; acrolentiginous melanomas show significant loss of these markers&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Therefore&#44; while there are no studies that clarify the role of dermoscopy and CRM in differentiating between acral Spitz nevus and acrolentiginous melanoma&#44; the excisional biopsy and histopathological study remain the diagnostic pillars for atypical acral pigmented lesions&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Guilherme Camargo Julio Valinoto&#58; Drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Felipe Henrique Yazawa Santos&#58; Drafting and editing of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Rute Facchini Lellis&#58; Design and planning of the study&#59; collection&#44; analysis&#44; and interpretation of data&#59; effective participation in research orientation&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Marcus Maia&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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