Intra-Oral Spitz Naevus: A Case Report

Abstract

The Spitz nevus, also known as benign juvenile melanoma or a nevus of epitheloid and spindle cells2, was first described by Sophie Spitz in 19481 and is most common in children and adolescents.3 They can present in three different ways: solitary nodular, multiple grouped, and multiple disseminated.3 The great majority of lesions are solitary, nodular, and are present in children and adolescents (57%–70%), with a slight preference for the female gender. The regions where they are most frequently found are the lower extremities, the head and neck, and the trunk.4 A Spitz nevus is usually pink, brown, or black in color. After an initial period of growth, the majority of Spitz nevi tend to stabilize their growth, reaching, in 95% of patients, a final size smaller than 6 mm.5 Histopathologically, a Spitz nevus is very similar to a melanoma due to the large size of the spindle or polygonal cells, frequently containing considerable cellular and nuclear pleomorphisms, the presence of inflammatory infiltrate, and, on the base of the lesion, a diminished cell size and spread among the collagen fibers of the conjunctive tissue. The difference between the Spitz nevus and a malignant melanoma can be hard to detect, but its structural pattern, which resembles a normal nevus, and its cytological traits, such as the large spindle and epithelioid cells, can be useful in making this distinction. The majority of Spitz Nevi are small and well circumscribed.5 Those lesions that are particularly hard to distinguish from malignant melanoma are called atypical or malignant Spitz nevi and Spitzoid cells.6,7,8 Immunohistochemical studies can help, but they are still not definitive.9,7 A Spitz Nevus expresses the S100 protein, but HMB-45 tends to be distributed more within the junctional and superficial components of the skin. HMB-45 correlates with melanosome production and thus, HMB-45-positive cells are of melanocytic origin. Therefore, HMB-45 may correlate best with factors that stimulate melanocytic proliferation and the production of melanosomes.8 The treatment indicated is complete excision to determine the lesion’s depth and extension.10 Despite the fact that the Spitz nevus is a benign lesion, its transformation into a malignant lesion has been reported. Therefore, its proservation must be recommended.11