Acral pigmented Spitz nevus in a child with transepidermal migration of melanocytes: Dermoscopic and reflectance confocal microscopic features

Acral pigmented Spitz nevi are seldom reported in the literature. We report a new case on the palm of a 4-year-old girl that demonstrated correlation between features observed on dermoscopy and reflectance confocal microscopy (RCM). Histopathology revealed a benign intraepidermal Spitz nevus with transepidermal elimination of melanocytes that showed on RCM as focal atypical bright cells concerning for malignancy. This case is one of few reports in the literature combining dermoscopy, reflectance confocal microscopy, and histology for an acral Spitz nevi, which are rarely evaluated by RCM given the thickness of the stratum corneum in acral sites.