de Giorgi V, Sestini S, Massi D, Papi F, Lotti T
Department of Dermatology, University of Florence, Florence, Italy.
Clin Exp Dermatol. 2008 May;33(3):309-11. doi: 10.1111/j.1365-2230.2007.02639.x. Epub 2008 Jan 14.
It is a common experience that many Spitz naevi deviate from the idealized or stereotypical representation found in the literature, often causing considerable difficulties in distinguishing them from melanoma. The diagnostic term 'atypical Spitz naevus' is used to describe lesions that deviate from the typical appearance of Spitz naevi and which have an uncertain biological significance and prognosis. The term 'Spitz tumour' has been proposed for these lesions, as the term 'naevus' indicates a lesion that is completely benign and presents no risk to the patient. We present a case of atypical Spitz tumour with peculiar atypical clinical and dermatoscopic features. The difficulty in managing this Spitz tumour was aggravated by the clinical diagnosis. In fact, the lesion appeared as a benign and nonmelanocytic lesion, a pigmented dermatofibroma. Our case underlines the difficulties present in the controversial chapter of spitzoid melanocytic lesions. The atypical Spitz tumour is a 'chameleon' lesion that can mimic not only melanocytic, but also nonmelanocytic lesions.
许多Spitz痣与文献中理想化或刻板的表现有所不同，这是一种常见的情况，常常给将它们与黑色素瘤区分开来带来相当大的困难。诊断术语“非典型Spitz痣”用于描述那些偏离Spitz痣典型外观且生物学意义和预后不确定的病变。对于这些病变，有人提出了“Spitz肿瘤”这一术语，因为“痣”这个词表示一种完全良性且对患者无风险的病变。我们报告一例具有独特非典型临床和皮肤镜特征的非典型Spitz肿瘤病例。临床诊断加重了处理这个Spitz肿瘤的难度。事实上，该病变表现为良性非黑素细胞性病变，即色素性皮肤纤维瘤。我们的病例凸显了Spitz样黑素细胞性病变这一有争议领域存在的困难。非典型Spitz肿瘤是一种“变色龙”样病变，它不仅可以模仿黑素细胞性病变，还能模仿非黑素细胞性病变。
