J Korean Med Sci.  2012 Apr;27(4):454-457. 10.3346/jkms.2012.27.4.454.

A Case of Spitzoid Melanoma with Lymph Node Metastasis in a Child

• Kim JY
• Choi JE
• Ahn HH
• Kye YC
• Seo SH

• KMID: 2157910
• DOI: http://doi.org/10.3346/jkms.2012.27.4.454

Abstract

The distinction of a spitz nevus from a melanoma can be difficult and in some cases, impossible. A misdiagnosed spitz nevus can metastasize and lead to fatal outcomes, especially in children. A 5-yr-old girl presented with a 1-yr history of a solitary pinkish nodule on her left hand. On physical examination, she had a palpable left axillary lymph node. We performed biopsy and checked 3 sentinel lymph nodes (SLN) on her axillary area. The biopsy specimen showed multiple variably sized and shaped nests with large spindle or polygonal cells and SLN biopsy showed 3 of 3 lymph nodes that were metastasized. Under the diagnosis of spitzoid melanoma, she was treated with excision biopsy and complete left axillary lymph nodes were dissected. She received interferon-alpha2b subcutaneously at a dose of 8 MIU per day, 3 times weekly for 12 months, and shows no recurrence.

Keyword

Child; Lymph Node Metastasis; Spitz Nevus; Spitzoid Melanoma

MeSH Terms

Antineoplastic Agents/therapeutic use
Child, Preschool
Female
Humans
Interferon-alpha/therapeutic use
Lymphatic Metastasis
Melanoma/drug therapy/*pathology/surgery
*Nevus, Epithelioid and Spindle Cell
Recombinant Proteins/therapeutic use
Skin Neoplasms/drug therapy/*pathology/surgery

Figure

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  Fig. 1 Gross view of the skin lesion. (A) Slightly tender, solitary pinkish protruding nodule on the lateral side of the dorsum of her left hand. (B) Dermoscopic photo of lesion.

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  Fig. 2 Histopathology of the skin lesion. (A) Abundant irregular nests of different sizes and shapes and asymmetrical proliferation of enlarged atypical epithelioid and spindle shaped melanocytes in the deep dermis. No maturation of cells from near the surface to the base (H&E stain, × 40). (B) At high power magnification, atypical epithelioid and spindle shaped melanocytes with large, hyperchromatic, pleomorphic nuclei were observed (H&E stain, × 100).

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  Fig. 3 Immunohistochemistry of the skin lesion. (A) Melan-A is positive at the whole skin level (Melan-A, × 12.5) and (B) weakly positive for HMB-45 (HMB-45, × 12.5).

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  Fig. 4 Immunohistochemistry of the lymph nodes. (A) The biopsy specimen from the axillary lymph node shows positive results for Melan-A (Melan-A, × 12.5). (B) Atypical melanocytes found within the lymph node parenchyma (Melan-A, × 40).

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