personal and familiar anamneses for skin tumours/melanoma
were negative, and she presented with otherwise common nevi
count, without any signiﬁcant dermoscopic atypia. During clini-
cal and dermoscopic evaluation of plantar lesion, lesion had
asymmetrical clinical shape and dermoscopically clear-cut paral-
lel ridge pattern with few peripheral globules (
Fig. 1). Pigment
localized to the ridges (i.e., parallel ridge pattern) is highly sug-
gestive for melanoma and, in fact, carries diagnostic accuracy of
82% for melanoma, with a sensitivity of 86%, speciﬁcity of 99%,
a positive predictive value of 94% and a negative predictive value
There are exceptions to the rule of parallel ridge pat-
tern, such as lentiginoses, repetitive trauma-induced pigmenta-
tion, congenital nevi, exogenous pigmentation and subcorneal
Therefore, urgent excision of this lesion was
made. Histopathologically, the lesion was atypical because show-
ing indistinct intra-epidermal borders and some upward spread
of melanocytes. Nevertheless, it was small-sized, with a prevail-
ingly nested growth pattern and a very uniform distribution of
pigment; ‘clefts’ around junctional nests (‘capping’) and around
single melanocytes (‘microcapping’) were prominent features.
Cytomorphology featured monomorphic spindle-shaped mela-
nocytes consistent with a pigmented spindle cell Spitz nevus
Spitz nevi can occur anywhere on the skin but they show pref-
erential locations, including face, extremities and buttocks. Spitz
nevi located on acral skin are quite rare. According to Banba
et al., they occur only in 2% of all cases and, among them, only
a minority are pigmented.
The diagnosis of Spitz nevus was
suspected in our case because of the young age of the patient
and the fast growth of the lesion. However, the presence of a
clear-cut parallel ridge pattern prompted excision to rule out
In conclusion, we described a pigmented Spitz nevus located
on acral site that showed parallel ridge pattern. It is well known
that Spitz nevus can be often a melanoma simulator, and this
seems true not only when the lesion is located on face, trunk and
extremities, but also when it is found on acral skin.
* M. Bradamante,
University Department of Dermatology and Venereology, School of
Medicine, University Hospital Center, Zagreb, Croatia,
Pathology Unit, Hospital of Macerata, Macerata, Italy,
Nuovo Policlinico (ediﬁcio 9C), University of Campania, Naples, Italy
*Correspondence: R. Juraki
c, E-mail: firstname.lastname@example.org
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Erosive pustular dermatosis of
the scalp and Kindler syndrome:
a new association
Erosive pustular dermatosis of the scalp (EPDS) is a rare inﬂam-
matory disease that predominantly affects elderly people, with a
Figure 1 Clinical and dermoscopic photography of the lesion.
Figure 2 Histopathology.
© 2017 European Academy of Dermatology and Venereology
2018, 32, e86–e121
Letters to the Editor