Teresa Lopes de Magalhães
1, Sofia Poço Miranda
2, Diana Bernardo
3, Alexandra Azevedo
3, Susana Machado
31Pediatric Department, Unidade Local Saúde do Oeste, Caldas da Rainha, Leiria, Portugal,
2Pediatric Department, Unidade Local Saúde do Alto Minho, Viana do Castelo, Portugal,
3Dermatology Department, Unidade Local Saúde de Santo António, Porto, Portugal
Address for Correspondence: Teresa Gamelas Neves Lopes de Magalhães, Rua Diário de Notícias. 2500 – 176, Caldas da Rainha.
Email: teresagmag@gmail.com
Keywords : Child, Dermatology, Nevus, Epithelioid and spindle cell.
Question: Case 1
A six-year-old male child, otherwise healthy, was referred to the dermatology department for a pink papular skin lesion on the right lower limb (Figure 1), which was progressively growing over 4 months, without associated itching, bleeding, or pain. On physical examination, the lesion measured approximately 6 mm in diameter with irregular borders and elevated topography. Dermatoscopy did not show the typical starburst or peripheral globular patterns, instead revealing nonspecific vascular structures. An excisional biopsy was performed and the histopathological report revealed a symmetric and well-demarcated compound melanocytic proliferation, predominantly composed of spindle-shaped, voluminous melanocytes. There was no atypia and rare superficial mitotic figures were observed. Surgical excision was complete and the margins were clear.
Figure 1. Pink papular skin lesion on the right lower limb.
Case 2
A three-year-old female child, without any significant medical history, was referred to a dermatology appointment due to the appearance of an erythematous-violaceous nodule approximately 10 mm in diameter on the right flank (Figure 2), which had been progressively growing over 5 months. On physical examination, the lesion measured 10 mm in diameter, with irregular borders, an elevated topography and signs of ulceration. An excisional biopsy of the lesion was performed and histopathological analysis confirmed a Spitz nevus. The lesion exhibited a symmetric architecture with sharply demarcated borders and was predominantly composed of spindle cells. Notably, the analysis revealed a rare mitotic rate, indicating very few mitotic figures in the tissue sample. This is a critical histopathological finding, as a low mitotic rate is characteristic of benign lesions and reflects minimal cellular proliferation. The absence of frequent mitoses, along with the lack of other atypical features (pleomorphism, disorganized growth, or deep tissue invasion), strongly supported the benign nature of the lesion. Consequently, these findings eliminated the need for additional molecular studies, as there was no evidence of atypia or malignancy.
Figure 2. Eerythematous-violaceous nodule on the right flank.
