A case of Spitz nevus was misdiagnosed as hemangioma

A case of Spitz nevus is reported. A 5-year-old girl was diagnosed with hemangioma because of a 3-month history of red lesions on her right face. Following the treatment with pulse dye laser, blisters appeared. After the blisters dried up, the red masses rapidly elevated with increase in number over the enlarged erythema. Dermatological examination showed a demarcated erythema about 1.5 cm×1.0 cm on the face, on which there were multiple red spherical masses, sized rice grain to mung bean, with smooth surface. The masses slightly faded under pressure. Pathology of skin lesions showed mixed nevus. Nevus cells included spindle cells and epithelioid cells, with large spindle nuclei, obvious nucleoli, and active cell proliferation. Epithelioid cells were polygonal with clear boundaries, and visible fissures around melanocytes. Immunohistochemistry showed positive for HMB45 and Melan A, and negative for CD31 and CD34, Ki-67 about 10% positive. The diagnosis was Spitz nevus. Two weeks after the resection, the skin healed well, and no new skin lesions were found during the follow-up.