HISTOPATOLOGI
SPITZ NEVI
Two cylinders from typical Spitz nevi (H&E; original
magnification: × 100 (a, b) and × 400 (c, d)).Epithelioid or
spindle melanocytes with no significant cytological atypia
MELANOMA NODULAR
A large, well-circumscribed proliferation of atypical
melanocytes is seen growing throughout the dermis. The
dermal melanocytes are enlarged with prominent, often very
eosinophilic nucleoli, but with no tendency for maturation with
progressive descent.
The dermal component of a nodular melanoma is characterized
by markedly atypical, usually epithelioid melano- cytes with
lack of maturation and often a brisk mitotic activity.
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DERMOSCOPY OF NODULAR MELANOMA
SPITZ NEVI
The starburst pattern of pigmented Spitz (Reed) naevi. The pattern consists of a
hyperpigmented centre and symmetrically distributed peripheral pseudopods (a, b)
or streaks (c) or a combination of pseudopods and streaks (d)
MELANOMA NODULAR
Typical nodular pigmented melanoma. A, This asymmetrical pigmented nodule has
the significant positive predictors of blue-white veil, multiple (5-6) colors (scored
from tan, dark brown, red, blue, gray, and black), irregular blotches, irregular
brown dots and globules, and black color (Breslow thickness, 4.5 mm). B, This
asymmetrical pigmented nodule has a blue-white veil, irregular blotches, and
irregular dots and globules, some of which are black, that are found both in a
central and peripheral position (Breslow thickness, 5.0 mm). C, This asymmetrical
pigmented nodule has a blue-white veil, multiple brown dots (white arrows), 5 or 6
colors, peripheral black dots and globules, milky red and pink areas, and irregular
blotches (Breslow thickness, 6.7 mm). D, This asymmetrical pigmented nodule has
peripheral black dots and globules, irregular dots and globules (size and
distribution), pseudopods (arrow), and black color (Breslow thickness, 1.2 mm).
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DERMOSCOPY OF NODULAR MELANOMA
SPITZ NEVI MELANOMA NODULAR

Symmetrical pigmented nodular melanoma.

Although most nodular pigmented melanoma
lesions have asymmetrical pigmented patterns,
5.8% have symmetrical pigmentation, as seen
here. The Breslow thicknesses are A, 1.7 mm; B,
1.0 mm; C, 0.9 mm; and D, 4.3 mm.

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DERMOSCOPY OF NODULAR MELANOMA
SPITZ NEVI MELANOMA NODULAR

Amelanotic/hypomelanotic nodular melanoma (NM). A, This

hypomelanotic nodule has atypical vasculature shown as combinations of
dotted (thick arrow), linear irregular (thin black arrows), and hairpin
vessels (white arrows) (Breslow thickness, 2.2 mm). B, This lesion has a
central white patch mimicking a dermatofibroma. A total of 12.9% of
amelanotic/hypomelanotic NMs were reported to have central white
patches. In this case the ulceration led to a suspicion of malignancy
(Breslow thickness, 2.2 mm). C, This small-diameter hypomelanotic (light-
colored) nodule has asymmetrical pigmentation with areas of blue-white
veil (Breslow thickness, 0.94 mm). D, This hypomelanotic lesion has fine,
predominantly linear irregular vessels at the periphery of the nodule
(Breslow thickness,
1.87 mm). E, This amelanotic nodule has diffuse hairpin vessels throughout
the lesion in a symmetrical pattern (Breslow thickness, 2.0 mm).

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 GEJALA KLINIS
SPITZ NEVI MELANOMA NODULAR

The lesion tends to grow rapidly and may reach a size of an intraepidermal neoplastic component which involves
1 cm within 6 months. Spitz nevi tend to become static less than three rete ridges at the edges of a dermal tumor
after the rapid initial growth phase; however, color mass.
changes may be observed, and bleeding and pruritus are
rarely noticed

Physical examination : Single, dome-shaped, red or
pigmented papules or nodules are typical. Most lesions
occur on the face or legs; rare cases of oral Spitz nevi
were also reported.. The color may vary from
nonpigmented through pink to orange-red. Some lesions
are pigmented, especially those found on lower
extremities. Note that the rare recurrences may mimic
metastatic malignant melanoma.
The clinical features of NM are distinct from radial
growth subtypes. NMs typically present as a rapidly
Expanding papule, nodule, or plaque. They are
occasionally polypoidal or even pedunculated .They are
usually well circumscribed and sym- metric. NMs may
be detected when they are small in diameter but
frequently reach a size of approximately 1 cm before
diagnosis. Surface ulceration is not uncommon and their
color is often black or blue, although a significant
propor- tion are amelanotic. The amelanotic variety
frequently has a subtle blush or peripheral rim of
pigment that provides a crucial diagnostic clue.