Letter to the Editor
Intra-Oral Spitz Naevus: A Case Report
Ruth Lopes de Freitas Xavier, Marcelo Gadelha Vasconcelos, Hébel Cavalcanti Galvão, Roseana de Almeida Freitas, Evânia Leiros de Souza, Leão Pereira Pinto
Faculdade de Odontologia da UFRN, Disciplina de Patologia Oral - Natal/RN, Brazil
Read
463
Timeswas read the article
270
Total PDF
193
Total HTML
Share statistics
array:24 [ "pii" => "S1807593222028563" "issn" => "18075932" "doi" => "10.1590/S1807-59322008000100023" "estado" => "S300" "fechaPublicacion" => "2008-02-01" "aid" => "2856" "copyright" => "CLINICS" "copyrightAnyo" => "2008" "documento" => "simple-article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "cor" "cita" => "Clinics. 2008;63:140-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S1807593222028575" "issn" => "18075932" "doi" => "10.1590/S1807-59322008000100024" "estado" => "S300" "fechaPublicacion" => "2008-02-01" "aid" => "2857" "copyright" => "CLINICS" "documento" => "simple-article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "cor" "cita" => "Clinics. 2008;63:143-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Atypical Perianal Herpes Simplex Infection in HIV-Positive Patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "143" "paginaFinal" => "146" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 681 "Ancho" => 511 "Tamanyo" => 90386 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Initial proctologic exam.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marcelo Simonsen, Sergio Carlos Nahas, Edesio Vieira da Silva Filho, Sergio Eduardo Alonso Araújo, Desiderio Roberto Kiss, Caio Sergio Rizkallah Nahas" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Marcelo" "apellidos" => "Simonsen" ] 1 => array:2 [ "nombre" => "Sergio Carlos" "apellidos" => "Nahas" ] 2 => array:2 [ "nombre" => "Edesio Vieira da Silva" "apellidos" => "Filho" ] 3 => array:2 [ "nombre" => "Sergio Eduardo Alonso" "apellidos" => "Araújo" ] 4 => array:2 [ "nombre" => "Desiderio Roberto" "apellidos" => "Kiss" ] 5 => array:2 [ "nombre" => "Caio Sergio Rizkallah" "apellidos" => "Nahas" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222028575?idApp=UINPBA00004N" "url" => "/18075932/0000006300000001/v1_202212060857/S1807593222028575/v1_202212060857/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1807593222028551" "issn" => "18075932" "doi" => "10.1590/S1807-59322008000100022" "estado" => "S300" "fechaPublicacion" => "2008-02-01" "aid" => "2855" "copyright" => "CLINICS" "documento" => "simple-article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "cor" "cita" => "Clinics. 2008;63:136-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Isolated Left Ventricular Noncompaction: Unusual Cause of Decompensated Heart Failure and Indication of Heart Transplantation in the Early Infancy - Case Report and Literature Review" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "136" "paginaFinal" => "139" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 521 "Ancho" => 467 "Tamanyo" => 42149 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Gross aspect of the explanted heart, showing the characteristic non-compaction involving the inlet and apical portion of the left ventricle but sparing the ventricular septum.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Natasha Damásio Fairbanks Barbosa, Estela Azeka, Vera Demarchi Aiello, Fernanda Viana, Marcelo Jatene, Carla Tanamati, Miguel Barbero Marcial" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Natasha Damásio Fairbanks" "apellidos" => "Barbosa" ] 1 => array:2 [ "nombre" => "Estela" "apellidos" => "Azeka" ] 2 => array:2 [ "nombre" => "Vera Demarchi" "apellidos" => "Aiello" ] 3 => array:2 [ "nombre" => "Fernanda" "apellidos" => "Viana" ] 4 => array:2 [ "nombre" => "Marcelo" "apellidos" => "Jatene" ] 5 => array:2 [ "nombre" => "Carla" "apellidos" => "Tanamati" ] 6 => array:2 [ "nombre" => "Miguel Barbero" "apellidos" => "Marcial" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222028551?idApp=UINPBA00004N" "url" => "/18075932/0000006300000001/v1_202212060857/S1807593222028551/v1_202212060857/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Intra-Oral Spitz Naevus: A Case Report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "140" "paginaFinal" => "142" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Ruth Lopes de Freitas Xavier, Marcelo Gadelha Vasconcelos, Hébel Cavalcanti Galvão, Roseana de Almeida Freitas, Evânia Leiros de Souza, Leão Pereira Pinto" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Ruth Lopes" "apellidos" => "de Freitas Xavier" "email" => array:1 [ 0 => "xavier_ruth@msn.com" ] ] 1 => array:2 [ "nombre" => "Marcelo Gadelha" "apellidos" => "Vasconcelos" ] 2 => array:2 [ "nombre" => "Hébel Cavalcanti" "apellidos" => "Galvão" ] 3 => array:2 [ "nombre" => "Roseana" "apellidos" => "de Almeida Freitas" ] 4 => array:2 [ "nombre" => "Evânia Leiros" "apellidos" => "de Souza" ] 5 => array:2 [ "nombre" => "Leão Pereira" "apellidos" => "Pinto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Faculdade de Odontologia da UFRN, Disciplina de Patologia Oral - Natal/RN, Brazil" "identificador" => "af1" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 764 "Ancho" => 994 "Tamanyo" => 164577 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Photomicrography on H/E - 100x – where the organization of nests can be seen more superficially and, more deeply in the conjunctive tissue, the spread of nevoid cells.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">The Spitz nevus, also known as benign juvenile melanoma or a nevus of epitheloid and spindle cells<a class="elsevierStyleCrossRef" href="#bib2">2</a>, was first described by Sophie Spitz in 1948<a class="elsevierStyleCrossRef" href="#bib1">1</a> and is most common in children and adolescents.<a class="elsevierStyleCrossRef" href="#bib3">3</a> They can present in three different ways: solitary nodular, multiple grouped, and multiple disseminated.<a class="elsevierStyleCrossRef" href="#bib3">3</a> The great majority of lesions are solitary, nodular, and are present in children and adolescents (57%–70%), with a slight preference for the female gender. The regions where they are most frequently found are the lower extremities, the head and neck, and the trunk.<a class="elsevierStyleCrossRef" href="#bib4">4</a> A Spitz nevus is usually pink, brown, or black in color. After an initial period of growth, the majority of Spitz nevi tend to stabilize their growth, reaching, in 95% of patients, a final size smaller than 6 mm.<a class="elsevierStyleCrossRef" href="#bib5">5</a></p><p id="para20" class="elsevierStylePara elsevierViewall">Histopathologically, a Spitz nevus is very similar to a melanoma due to the large size of the spindle or polygonal cells, frequently containing considerable cellular and nuclear pleomorphisms, the presence of inflammatory infiltrate, and, on the base of the lesion, a diminished cell size and spread among the collagen fibers of the conjunctive tissue. The difference between the Spitz nevus and a malignant melanoma can be hard to detect, but its structural pattern, which resembles a normal nevus, and its cytological traits, such as the large spindle and epithelioid cells, can be useful in making this distinction. The majority of Spitz Nevi are small and well circumscribed.<a class="elsevierStyleCrossRef" href="#bib5">5</a></p><p id="para30" class="elsevierStylePara elsevierViewall">Those lesions that are particularly hard to distinguish from malignant melanoma are called atypical or malignant Spitz nevi and Spitzoid cells.<a class="elsevierStyleCrossRef" href="#bib6">6</a>,<a class="elsevierStyleCrossRef" href="#bib7">7</a>,<a class="elsevierStyleCrossRef" href="#bib8">8</a> Immunohistochemical studies can help, but they are still not definitive.<a class="elsevierStyleCrossRef" href="#bib9">9</a>,<a class="elsevierStyleCrossRef" href="#bib7">7</a> A Spitz Nevus expresses the S100 protein, but HMB-45 tends to be distributed more within the junctional and superficial components of the skin. HMB-45 correlates with melanosome production and thus, HMB-45-positive cells are of melanocytic origin. Therefore, HMB-45 may correlate best with factors that stimulate melanocytic proliferation and the production of melanosomes.<a class="elsevierStyleCrossRef" href="#bib8">8</a></p><p id="para40" class="elsevierStylePara elsevierViewall">The treatment indicated is complete excision to determine the lesion’s depth and extension.<a class="elsevierStyleCrossRef" href="#bib10">10</a> Despite the fact that the Spitz nevus is a benign lesion, its transformation into a malignant lesion has been reported. Therefore, its proservation must be recommended.<a class="elsevierStyleCrossRef" href="#bib11">11</a></p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">CASE REPORT</span><p id="para50" class="elsevierStylePara elsevierViewall">Patient D. B. S., a 32-year-old female, with pheoderma, who was a non-smoker and non-drinker, came to the Service of Oral Diagnostics at the Federal University of Rio Grande do Norte - Brazil, complaining about a lesion on the superior lip, which she had for 5 years. The intra-oral exam showed the presence of a nodule with irregular edges, a pinkish, asymptomatic, flat surface with a soft consistency, and sessile implantation. The lesion was exophytic with no bleeding, soreness or local traumatic factor, and its largest diameter was 0.5 cm. The intra-oral exam did not detect cervical lymphadenopathy. The patient said the lesion had increased its volume over a period of 5 years and had then stopped.</p><p id="para60" class="elsevierStylePara elsevierViewall">An excisional biopsy was performed and the fragment was removed and sent to the Service of Pathological Anatomy of the Discipline Oral Pathology, Federal University of Rio Grande do Norte - Brazil, where it was processed, stained using routine techniques, and examined. Histologically, an oral mucosa covered by a stratified orthokeratinized squamous epithelium was evident, showing atrophy and soft hyperplasia. Clear cytoplasm cells were seen all around the tissue density, suggesting nevoid cells. On the underlying conjunctive tissue, the proliferation of nevoid cells could be seen, which, on more superficial portions, organized themselves into variable-sized nests, exhibiting a raised volume, multi-nucleation and hyperchromatism due to their melanin deposition. At deeper levels, these cells lost their cohesion and acquired a more oval-shaped and fusiform aspect (<a class="elsevierStyleCrossRefs" href="#fig1">figures 1 and 2</a>). Because of these findings, the histopathological diagnosis was a case of Spitz nevus.</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><elsevierMultimedia ident="fig2"></elsevierMultimedia></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">DISCUSSION</span><p id="para70" class="elsevierStylePara elsevierViewall">The occurrence of the intra-oral Spitz nevus is very rare, having been reported previously in the international literature only twice. In 1990, Nikai et al<a class="elsevierStyleCrossRef" href="#bib12">12</a> reported a Spitz nevus case on the palate, and in 2007, Seehra et al<a class="elsevierStyleCrossRef" href="#bib11">11</a> reported another intra-oral case on the superior lip mucosa. Our case, then, would be the third intra-oral case, and only the second to be to be reported of a Spitz Nevus on the superior lip.</p><p id="para80" class="elsevierStylePara elsevierViewall">Herreid and Shapiro<a class="elsevierStyleCrossRef" href="#bib13">13</a>, in comparing the distribution of the Spitz nevus and malignant melanoma by age, verified that the age range for the Spitz nevus was between 6 months and 72 years old, with an average of 21 years. The patient in the case presented here was 32 years old, which is within this age range, also corroborating the study of Cesinaro et al<a class="elsevierStyleCrossRef" href="#bib14">14</a>, where adults represented the highest proportion of Spitz nevus patients.</p><p id="para90" class="elsevierStylePara elsevierViewall">Since it can be difficult to distinguish between a Spitz nevus and malignant melanoma, the complete removal of a solitary Spitz nevus is recommended. Research done by the American Academy of Dermatology found that 80% recommend removal of the lesion with 1 to 2 mm borders.<a class="elsevierStyleCrossRef" href="#bib15">15</a> Since the case presented here is of a pigmented lesion, the surgeon decided to include a 3mm safety margin and, since the histopathological diagnosis indicated a case of Spitz nevus, the treatment was in accordance with the recommendations in the literature.</p><p id="para100" class="elsevierStylePara elsevierViewall">Gelbard et al.<a class="elsevierStyleCrossRef" href="#bib15">15</a> report that 74% of the dermatologists interviewed believe that Spitz Nevus is a benign entity, however, 4% believe it is a precursor lesion to a malignant melanoma. Seven percent of general dermatologists and 4% of pediatric dermatologists have seen metastatic melanomas that originated from lesions initially histologically diagnosed as Spitz nevi, thus, the follow-up recommended by Seehra et al<a class="elsevierStyleCrossRef" href="#bib11">11</a> must be done.</p><p id="para110" class="elsevierStylePara elsevierViewall">Some studies have suggested clinical and histological criteria to evaluate the malignant potential of the Spitz nevus, including diameter greater than 1 cm, subcutaneous tumor depth, the presence of soreness, and high mitotic index.<a class="elsevierStyleCrossRef" href="#bib16">16</a>,<a class="elsevierStyleCrossRef" href="#bib17">17</a> The lesion of the case presented here measured 0.5 cm at its largest diameter without fat involvement, ulceration, bleeding, or a high mitotic index, characterizing the lesion as low risk. However, these studies focus mainly on clinical and histological characteristics rather than the immunohistochemical patterns. Under the gradation system suggested by Spatz<a class="elsevierStyleCrossRef" href="#bib16">16</a>, despite its applicability only to children and adolescents, the patient presented here had a low risk lesion.</p><p id="para120" class="elsevierStylePara elsevierViewall">Since the Spitz nevus presents a different diagnosis from that of the extremely important malignant melanoma, it is recommended that pigmented lesions be completely and safely removed with adequate patient follow up after all due procedures, since there are reports in the literature about the malignant potential of this entity.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "cesec10" "titulo" => "INTRODUCTION" ] 1 => array:2 [ "identificador" => "cesec20" "titulo" => "CASE REPORT" ] 2 => array:2 [ "identificador" => "cesec30" "titulo" => "DISCUSSION" ] 3 => array:1 [ "titulo" => "REFERENCES" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 764 "Ancho" => 994 "Tamanyo" => 164577 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Photomicrography on H/E - 100x – where the organization of nests can be seen more superficially and, more deeply in the conjunctive tissue, the spread of nevoid cells.</p>" ] ] 1 => array:7 [ "identificador" => "fig2" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 764 "Ancho" => 994 "Tamanyo" => 159905 ] ] "descripcion" => array:1 [ "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Photomicrography on H/E - 400x – showing the cellular and nuclear pleomorphism, hyperchromatism and multi nucleation.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec10" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melanomas of childhood" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ S Spitz \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "1948" "volumen" => "24" "paginaInicial" => "591" "paginaFinal" => "609" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The clinical spectrum of pigmented lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ JV Schaffer \n \t\t\t\t\t\t\t\t """ 1 => """ JL Bolognia \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Plast Surg" "fecha" => "2000" "volumen" => "27" "paginaInicial" => "391" "paginaFinal" => "408" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10941560" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Spitz tumor 50 years later: revisting a landmark contribuition and unresolved controversy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ A Spatz \n \t\t\t\t\t\t\t\t """ 1 => """ RL Barnhill \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0190-9622(99)70192-1" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1999" "volumen" => "40" "paginaInicial" => "223" "paginaFinal" => "228" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10025749" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple agminate Spitz naevi" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ H Hamm \n \t\t\t\t\t\t\t\t """ 1 => """ R Happle \n \t\t\t\t\t\t\t\t """ 2 => """ EB Brocker \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.1987.tb04932.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "1987" "volumen" => "117" "paginaInicial" => "511" "paginaFinal" => "522" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3314974" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ D Elder \n \t\t\t\t\t\t\t\t """ 1 => """ R Elenitsas \n \t\t\t\t\t\t\t\t """ 2 => """ C Jaworsky \n \t\t\t\t\t\t\t\t """ 3 => """ B Johnson Jr \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Lever’s Histopathology of the skin" "paginaInicial" => "640" "paginaFinal" => "643" "edicion" => "8" "serieFecha" => "1997" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sentinel lymph node biopsy for patients with problematic spitzoid melanocytic lesions: a report on 18 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ LD Su \n \t\t\t\t\t\t\t\t """ 1 => """ DR Fullen \n \t\t\t\t\t\t\t\t """ 2 => """ VK Sondak \n \t\t\t\t\t\t\t\t """ 3 => """ TM Johnson \n \t\t\t\t\t\t\t\t """ 4 => """ L Lowe \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/cncr.11074" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "2003" "volumen" => "97" "paginaInicial" => "499" "paginaFinal" => "507" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12518375" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Persistent (recurrent) Spitz nevi: a histopathologic, immunohistochemical, and molecular pathologic study of 22 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ JD Harvell \n \t\t\t\t\t\t\t\t """ 1 => """ BC Bastian \n \t\t\t\t\t\t\t\t """ 2 => """ PE Leboit \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00000478-200205000-00012" "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "2002" "volumen" => "26" "paginaInicial" => "654" "paginaFinal" => "661" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11979096" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spindle cell and epithelioid cell nevi with atypia and metastasis (malignant Spitz nevus)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ KJ Smith \n \t\t\t\t\t\t\t\t """ 1 => """ TL Barrett \n \t\t\t\t\t\t\t\t """ 2 => """ HG Skelton 3rd \n \t\t\t\t\t\t\t\t """ 3 => """ GP Lupton \n \t\t\t\t\t\t\t\t """ 4 => """ JH Grahan \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00000478-198911000-00003" "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "1989" "volumen" => "13" "paginaInicial" => "931" "paginaFinal" => "939" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2802011" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dome-shaped partly umblicated tumor on the ear: Spit nevus (SN)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ V Filo \n \t\t\t\t\t\t\t\t """ 1 => """ S Galbavy \n \t\t\t\t\t\t\t\t """ 2 => """ J Pec \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arc Dermatol" "fecha" => "1998" "volumen" => "134" "paginaInicial" => "1629" "paginaFinal" => "1632" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathology quiz case: diagnosis: Spitz Nevus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ TP Nowlin 4th \n \t\t\t\t\t\t\t\t """ 1 => """ JH Freeman \n \t\t\t\t\t\t\t\t """ 2 => """ B Cable \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archotol.132.3.349" "Revista" => array:6 [ "tituloSerie" => "Arch Otolaryngol Head Neck Surg" "fecha" => "2006" "volumen" => "132" "paginaInicial" => "349" "paginaFinal" => "351" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16549759" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intraoral Spitz naevus: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ J Seehra \n \t\t\t\t\t\t\t\t """ 1 => """ P Sen \n \t\t\t\t\t\t\t\t """ 2 => """ R Lloyd \n \t\t\t\t\t\t\t\t """ 3 => """ P Sloan \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Oral Maxillofac Surg" "fecha" => "2007" "volumen" => "26" "paginaInicial" => "661" "paginaFinal" => "662" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spitz Nevus of the palate: report of a case" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ H Nikai \n \t\t\t\t\t\t\t\t """ 1 => """ M Miyauchi \n \t\t\t\t\t\t\t\t """ 2 => """ I Ogawa \n \t\t\t\t\t\t\t\t """ 3 => """ T Takata \n \t\t\t\t\t\t\t\t """ 4 => """ Y Hayashi \n \t\t\t\t\t\t\t\t """ 5 => """ H Okazaki \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0030-4220(90)90244-m" "Revista" => array:6 [ "tituloSerie" => "Oral Surg Oral Med Oral Pathol" "fecha" => "1990" "volumen" => "69" "paginaInicial" => "603" "paginaFinal" => "608" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2333213" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Age distribution of Spitz Nevus vs malignant Melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ PA Herreid \n \t\t\t\t\t\t\t\t """ 1 => """ PE Shapiro \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.132.3.352" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1996" "volumen" => "132" "paginaInicial" => "352" "paginaFinal" => "353" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8607649" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spitz nevus is relatively frequent in adults: A clinic-pathologic study of 247 cases related to patient’s age" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ AM Cesinaro \n \t\t\t\t\t\t\t\t """ 1 => """ M Foroni \n \t\t\t\t\t\t\t\t """ 2 => """ P Sighinolfi \n \t\t\t\t\t\t\t\t """ 3 => """ M Migaldi \n \t\t\t\t\t\t\t\t """ 4 => """ GP Trentini \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.dad.0000185249.21805.d3" "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol" "fecha" => "2005" "volumen" => "27" "paginaInicial" => "469" "paginaFinal" => "475" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16314701" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of Spitz nevi. A survey of dermatologists in the United States" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ SN Gelbard \n \t\t\t\t\t\t\t\t """ 1 => """ JM Tripp \n \t\t\t\t\t\t\t\t """ 2 => """ AA Marqhoob \n \t\t\t\t\t\t\t\t """ 3 => """ AW Kopf \n \t\t\t\t\t\t\t\t """ 4 => """ KL Koeniq \n \t\t\t\t\t\t\t\t """ 5 => """ JY KIM \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mjd.2002.121031" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2002" "volumen" => "47" "paginaInicial" => "224" "paginaFinal" => "230" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12140468" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spitz tumors in children: a grading system for risc stratification" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ A Spatz \n \t\t\t\t\t\t\t\t """ 1 => """ E Calonje \n \t\t\t\t\t\t\t\t """ 2 => """ S Handfield-Jones \n \t\t\t\t\t\t\t\t """ 3 => """ RL Barnhill \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.135.3.282" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1999" "volumen" => "135" "paginaInicial" => "282" "paginaFinal" => "285" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10086449" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spitz nevus versus spitzoid malignant melanoma: an evaluation of the current distinguishing histopathologic criteria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ N Walsh \n \t\t\t\t\t\t\t\t """ 1 => """ K Crotty \n \t\t\t\t\t\t\t\t """ 2 => """ A Palmer \n \t\t\t\t\t\t\t\t """ 3 => """ S McCarthy \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0046-8177(98)90421-x" "Revista" => array:6 [ "tituloSerie" => "Hum Pathol" "fecha" => "1998" "volumen" => "29" "paginaInicial" => "1105" "paginaFinal" => "1112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9781649" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/18075932/0000006300000001/v1_202212060857/S1807593222028563/v1_202212060857/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/18075932/0000006300000001/v1_202212060857/S1807593222028563/v1_202212060857/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222028563?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 1 | 5 |
| 2024 October | 15 | 28 | 43 |
| 2024 September | 18 | 28 | 46 |
| 2024 August | 20 | 23 | 43 |
| 2024 July | 14 | 31 | 45 |
| 2024 June | 9 | 18 | 27 |
| 2024 May | 14 | 12 | 26 |
| 2024 April | 9 | 8 | 17 |
| 2024 March | 14 | 12 | 26 |
| 2024 February | 10 | 9 | 19 |
| 2024 January | 9 | 11 | 20 |
| 2023 December | 9 | 15 | 24 |
| 2023 November | 7 | 17 | 24 |
| 2023 October | 7 | 15 | 22 |
| 2023 September | 11 | 20 | 31 |
| 2023 August | 2 | 5 | 7 |
| 2023 July | 3 | 8 | 11 |
| 2023 June | 1 | 0 | 1 |
| 2023 May | 1 | 0 | 1 |
| 2023 April | 1 | 2 | 3 |
| 2023 March | 3 | 1 | 4 |
| 2023 February | 0 | 1 | 1 |
| 2023 January | 0 | 2 | 2 |
| 2022 December | 12 | 3 | 15 |
Show all