Agminated Spitz Nevi
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This 30-month-old boy was brought for evaluation of a cluster of 4 dark pink, firm, nonblanchable papules, ranging from 1 to 5 mm, near the right lateral canthus. The lesions were asymptomatic. The mother had noticed a small red papule near the eye when the child was 1 year old. It had gradually enlarged and a few similar appearing, smaller papules developed adjacent to the original lesion. The clinical impression of agminated Spitz nevi was confirmed via histopathological analysis of the lesions after their removal by a plastic surgeon.
These benign acquired nevi are derived from melanocytic cells. They usually appear in childhood or adolescence, most often on the face, less commonly on the extremities. They typically present as small, solitary, asymptomatic, pink or red, sometimes pigmented papules or nodules.1 However, they can occur as multiple lesions in a widespread distribution (disseminated type) or grouped pattern (agminated), as in this case. Agminated Spitz nevi are relatively rare, with fewer than 50 cases reported in the English literature.3-5 Agminated nevi have the same morphologic appearance as solitary nevi.3 They may remain small or gradually enlarge and can occur on areas of hyperpigmented or hypopigmented skin.3
The differential diagnosis of Spitz nevi includes epidermal nevi, basal cell carcinoma, juvenile xanthogranuloma, pyogenic granuloma, molluscum contagiousum, verrucae, melanocytic nevi, and melanoma. When a Spitz nevus is suspected, diagnosis is confirmed by biopsy. Although commonly benign, the lesion may possess atypical features with malignant potential.2 In addition, amelanotic melanoma may mimic Spitz nevi. Consultation with a dermatopathologist may be necessary to help differentiate benign and atypical Spitz nevi from melanoma.
Complete excision of Spitz nevi is recommended. In some cases, large areas of skin may be involved and excision with grafting may be required.2,3 Close followup is recommended for patients in whom complete excision is impossible.