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![Page 1: Problematic lesions in children. Moscarella E, et al. Dermatol Clin. 2013 Oct;31(4):535-47.2013.06.00 2013 Jul 10. Review.](https://reader033.fdocuments.in/reader033/viewer/2022051111/5542eb77497959361e8e112e/html5/thumbnails/1.jpg)
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Problematic lesions in children.Moscarella E, et al. Dermatol Clin. 2013 Oct;31(4):535-47.2013.06.00 2013 Jul 10. Review.
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L’asportazione di nevi benigni in età pediatrica, per l’esclusione di un melanoma è 20 volte più frequente rispetto a quella per gli adulti
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quali sono levere lesioni problematiche?
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Le lesioni melanocitarie problematiche in età pediatrica sono rappresentate da
-nevi congeniti
-nevi di Spitz
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fattori di rischio per lo sviluppo di melanoma in età pediatrica
-familiarità-immunosoppressione-malattie genetiche (es. xeroderma pigmentoso) -nevo melanocitico gigante
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MACCHIE NERE
Nevo acquisito
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MACCHIE NERE
Nevo acquisito:
nel bambino necessita di controllo solo se c’è immunodeficienza o familiarità per melanoma non necessaria la dermoscopia
accrescimento contemporaneo di più nevi: no controllo poiché il melanoma è unico
nevi soggetti a traumi: non vanno asportati
protezione solare: come per il resto della cute
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MACCHIE NERE
Nevo melanocitico congenito
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I nevi melanocitici congeniti comportano un elevato rischio per melanoma se paragonati ai nevi comuni
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MACCHIE NERE
Nevo melanocitico congenito:
1,4 % dei nati
alla nascita può rimanere misconosciuto perchè chiaro fattori favorenti: - familiarità - fumo materno - problemi gravidici
rischio di trasformazione malignase diametro > 1 cm chiedere consulenza
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MACCHIE NERE
Nevo congenito gigante
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Nevo congenito gigante:
> 7,6 cm
1: 20.000 nati 4-8% di trasformazione malignasoprattutto nel 1 anno di vitain particolare melanosi leptomeningeapiu frequente in caso di nevi multipli sulla linea mediana
nel 6% dei casi regredisce nel giro di 5 anni
MACCHIE NERE
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NEVO DI SPITZ
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NEVO DI SPITZ
Insorge tipicamente nell'infanzia, é rosa-rosso e ovalare sul volto e arti
quello di Reed compare piú spesso tra i 20 e i 30 anni, in donne, sugli arti inferiori
comuni le forme di passaggio
in genere < 1 cm
Non c'é associazione con il melanoma.
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NEVO DI SPITZ
versus
LESIONI SPITZOIDI ATIPICHE
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Nevo di Spitz -classico, pigmentato e regolare -diagnosticato facilmente con la clinica e la dermoscopia
può essere seguito in maniera conservativa
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Lesioni spitzoidi atipiche
nevi di Spitz -atipici-grandi (> 1 cm),-nodulari-ulcerati -che si modificano rapidamente
devono essere escissi
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Diagnosi differenziale
Il nevo di Spitz va distinto da un piccolo emangioma, dal granuloma piogenico, dal mastocitoma solitario, ma soprattutto dal melanoma (quasi inesistente in età pediatrica)
Dermoscopia con epiluminescenza: aspetto regolare, margini netti
Se la diagnosi è certa: nessuna terapia
L’asportazione in età pediatrica richiede l’anestesia generale e comporta maggiori cicatrici
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NEVO DI SUTTON
NEVO DI SUTTON
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NEVO BLU
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GRAZIE