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Skin-Melanocytic tumors
Pigmented spindle cell nevus
Author: Nat Pernick, M.D., PathologyOutlines.com, Inc.
Revised: 26 October 2009, last major update June 2009
Definition
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● Often recent onset, on proximal extremities or trunk of young adults (AJSP 1984;8:645), commonly women
● Clinically resembles melanoma
Terminology
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● Also called Reed’s nevus
Treatment and prognosis
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● Conservative but complete excision
● Does not recur
Clinical description
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● < 1 cm, solitary, deeply pigmented, well-circumscribed maculopapule
Clinical images
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Small and symmetrical lesion differs from Spitz nevus Various images
in its uniform dark blue-black pigmentation that may
suggest melanoma clinically (AFIP)
Small slightly raised dark lesion with defined borders
Dermoscopy images
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Prevalence of brown globules forming Pseudopods arranged regularly at the periphery
a rim around the lesion and retiform depigmentation at the center
Micro description
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● Some similarity with Spitz’s nevi
● Symmetric with cytologic maturation
● Nests and fascicles of spindled melanocytes along dermoepidermal junction and within dermal papillae
● May be junctional or compound
● Expansive not infiltrative growth pattern
● Extends no deeper than reticular dermis
● Nevus cells typically contain abundant melanin pigment, may be associated with melanophages
● Nuclei are monotonous, resemble normal keratinocytes and may have small nucleoli
● Often has architectural or cytologic atypia (Hum Path 1991;22:52)
● Variable lymphocytic infiltrate at base of lesion
● Variable transepidermal elimination of junctional nests
● No/rare mitotic figures
● Note: hypopigmented variant is similar, but without abundant melanin (J Cutan Pathol 2008;35 Suppl 1;87)
Micro images
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Source: AFIP
Bilaterally symmetrical lesion (fig A) has proliferation of nested melanocytes that "rain down" from the epidermis and expand the papillary dermis without involving the reticular dermis, lesional cells mature from superficial to deep (fig B), and the most lateral cells are in the form of a nest rather than single cells (well circumscribed) (fig C)
Some intraepidermal nests show clefts similar to Spitz nevi, but they more often blend imperceptibly with keratinocytes in a pigmented spindle cell nevus (fig B); mitotic figures in the epidermis are common but they are not numerous in the dermis; maturation towards a small nevoid cell at the base in the papillary dermis, without involvement of the reticular dermis, is typical
Bilaterally symmetrical lesion whose cells mature from epidermis to base of papillary dermis, respecting the reticular dermis interface (fig B); nucleolated lesional cells with abundant, coarse, dusty pigment are characteristic (fig C)
Other images
Symmetric pigmented tumors
Symmetric pigmented tumors Various images
Other images: symmetric pigmented tumor #1; #2; #3; #4; pigmented spindle cell tumor
Video
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● Pigmented Spindle Cell Nevus
Differential Diagnoses
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● Superficial spreading melanoma (Dermatol Online J 2004;10(2):5)
● Spitz nevus
Additional references
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● J Am Acad Dermatol 1993;28:565
End of Skin-Melanocytic Tumors > Pigmented spindle cell nevus
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