title: The stars within the melanocytic garden: unusual variants of Spitz naevi.
abstract: BACKGROUND
  Spitz naevi may present a wide spectrum of morphologies. Histopathologically, many variants, including desmoplastic, angiomatoid, verrucous/polypoid, plexiform, pagetoid, halo, myxoid, granulomatous and tubular Spitz naevi have been described. Clinical and dermoscopic features of these unusual variants of Spitz naevi have been reported only rarely.
  
  
  OBJECTIVE
  The aim of this study is to describe clinical, dermoscopic and histopathological features of uncommon morphological variants of Spitz naevi in order to raise awareness among clinicians about their peculiar patterns of presentation.
  
  
  METHODS
  We searched our image database retrospectively from 2004 to 2014 for images of excised tumours using Spitz/Reed naevus as a keyword.
  
  
  RESULTS
  A total of 307 excised skin lesions with a histopathological diagnosis of Spitz/Reed naevus were found. Among those we identified 13 uncommon variants of Spitz naevi including six cases of desmoplastic Spitz naevus, five cases of angiomatoid Spitz naevus and two cases of verrucous Spitz naevus. These lesions did not fulfil the already described dermoscopic criteria of Spitz naevi, with the exception of angiomatoid Spitz naevi, exhibiting a pinkish background and dotted vessels in dermoscopy. Desmoplastic Spitz naevi may be difficult to differentiate from dermatofibroma clinically, and from melanoma under dermoscopic examination. Verrucous Spitz naevi, despite their relatively unusual clinical features, show reassuring morphological clues histologically, which allows the differential diagnosis from an atypical spitzoid tumour.
  
  
  CONCLUSIONS
  In all cases an atypical melanocytic lesion could not be excluded under dermoscopy, thus warranting excision and histopathological examination.
authors.affiliation: Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Moscarella
authors.forename: S
authors.initials: S
authors.lastname: Al Jalbout
authors.forename: S
authors.initials: S
authors.lastname: Piana
authors.forename: G
authors.initials: G
authors.lastname: Argenziano
authors.forename: A
authors.initials: A
authors.lastname: Lallas
authors.forename: C
authors.initials: C
authors.lastname: Longo
authors.forename: R
authors.initials: R
authors.lastname: Hofmann-Wellenhof
authors.forename: I
authors.initials: I
authors.lastname: Zalaudek
mesh_terms: D000328:Adult; D002081:Buttocks; D046169:Dermoscopy; D005121:Extremities; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D018332:Nevus, Epithelioid and Spindle Cell / Q000473:pathology*; D012878:Skin Neoplasms / Q000473:pathology*; D060726:Torso