{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T07:14:59Z","timestamp":1771312499657,"version":"3.50.1"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>A 45-year-old woman presented with a black hemispherical plaque on her right lower leg that had developed three years ago without an obvious cause. The lesion gradually enlarged without pain or pruritus. After excision, histopathological examination revealed atypical Spitz nevus. At a dermatology specialty hospital, pathological review suggested superficial spreading melanoma. Immunohistochemistry revealed diffusely positivity for S100, Melan-A, Ki-67, P16, Sox-10 and HMB45. Molecular pathological testing revealed mutations in the TERT promoter and BRAF and CDKN2A\/B genes. Extended tumor resection with an intraoperative sentinel lymph node biopsy identified SN2\/2. Dissection of the right inguinal lymph nodes revealed melanoma metastasis in 10 of 14 lymph nodes, with Immunolohistochemistry showing diffusely positivity for Sox-10 and Melan-A. The final diagnosis was superficially spreading malignant melanoma with regional lymph node metastasis. Postoperative adjuvant therapy included systemic chemotherapy and targeted therapy. No recurrence was observed during the 2-year follow-up period.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1709633","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T06:34:15Z","timestamp":1771310055000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A case of superficial spreading malignant melanoma with sentinel lymph node metastasis misdiagnosed as \u201cpigmented nevus\u201d"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiaolin","family":"Bu","sequence":"first","affiliation":[{"name":"Department of Dermatology, Pudong Gongli Hospital, Shanghai University of Medicine & Health Sciences","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Guo","sequence":"additional","affiliation":[{"name":"Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liwei","family":"Feng","sequence":"additional","affiliation":[{"name":"School of Gongli Hospital Medical Technology, University of Shanghai for Science and Technology","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yeqiang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2493769","DOI":"10.1080\/07853890.2025.2493769","article-title":"Differences of clinical features, prognosis and genetic mutations in Chinese patients with Malignant melanoma and additional primary tumours","volume":"57","author":"Lin","year":"2025","journal-title":"Ann Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/JS9.0000000000002908","article-title":"Burden trend and forecasting analysis of Malignant skin melanoma from 1990 to 2021","volume":"111","author":"Wang","year":"2025","journal-title":"Int J Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1016\/S0140-6736(23)00821-8","article-title":"Cutaneous melanoma","volume":"402","author":"Long","year":"2023","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.889223","article-title":"The spectrum of spitz melanocytic lesions: from morphologic diagnosis to molecular classification","volume":"12","author":"Cheng","year":"2022","journal-title":"Front Oncol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"4211","DOI":"10.3390\/ijms23084211","article-title":"The morpho-molecular landscape of spitz neoplasms","volume":"23","author":"Dal Pozzo","year":"2022","journal-title":"Int J Mol Sci"},{"key":"B6","doi-asserted-by":"publisher","first-page":"5834","DOI":"10.3390\/cancers15245834","article-title":"Spitz tumors and melanoma in the genomic age: A retrospective look at Ackerman\u2019s conundrum","volume":"15","author":"Urso","year":"2023","journal-title":"Cancers (Basel)"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1661983","article-title":"Malignant melanoma with pituitary metastasis: A case report and literature review","volume":"16","author":"Li","year":"2025","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s10014-025-00508-0","article-title":"Primary pigmented papillary epithelial tumor of the sella: case report and literature review","volume":"42","author":"Wu","year":"2025","journal-title":"Brain Tumor Pathol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"152550","DOI":"10.1016\/j.prp.2019.152550","article-title":"Utility of p16-Ki-67-HMB45 score in sorting benign from Malignant Spitz tumors","volume":"215","author":"Garola","year":"2019","journal-title":"Pathol Res Pract"},{"key":"B10","doi-asserted-by":"crossref","DOI":"10.1111\/cup.14798","article-title":"Spitz spindle cell\/reed nevus with SQSTM1:: NTRK2 fusion and atypical features in an older male patient: A case report and review of literature","volume":"52","author":"Scarf\u00f2","year":"2025","journal-title":"J Cutan Pathol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1111\/cup.13842","article-title":"BRAF fusion Spitz neoplasms; clinical morphological, and genomic findings in six cases","volume":"47","author":"Kim","year":"2020","journal-title":"J Cutan Pathol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.77180","article-title":"Spitz nevus arising within a black ink tattoo: A case report of an extremely rare entity","volume":"17","author":"Petkova","year":"2025","journal-title":"Cureus"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1159\/000533385","article-title":"Atypical presentation of spitz nevus: A case report","volume":"9","author":"Araiza-Atanacio","year":"2023","journal-title":"Skin Appendage Disord"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-020-02992-5","article-title":"GOPC-ROS1 mosaicism in agminated Spitz naevi: report of two cases","volume":"479","author":"Goto","year":"2021","journal-title":"Virchows Arch"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1111\/pde.14535","article-title":"Clinical and dermoscopic polymorphisms in agminated Spitz nevi: Ugly presentation but benign behavior","volume":"38","author":"De Giorgi","year":"2021","journal-title":"Pediatr Dermatol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.2147\/CCID.S349749","article-title":"Red spitz tumor\u201d on the ear: case report and review of the literature","volume":"15","author":"Liang","year":"2022","journal-title":"Clin Cosmet Investig Dermatol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.15570\/actaapa.2021.30","article-title":"Rapid dermoscopic evolution of a Spitz nevus in an adult masquerading as melanoma","volume":"30","author":"Pavlovi\u0107","year":"2021","journal-title":"Acta Dermatovenerol Alp Pannonica Adriat"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1097\/DAD.0000000000002865","article-title":"LMNA::NTRK1 and PRDX1::NTRK1 atypical spitz tumor: A report of two additional cases with histological, immunohistochemical, and molecular insights","volume":"47","author":"Cazzato","year":"2025","journal-title":"Am J Dermatopathol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1097\/DAD.0000000000002148","article-title":"Concomitant\u201d Cutaneous and nodal spitz nevus\/tumor: A new scenario for an old problem","volume":"44","author":"Ferrara","year":"2022","journal-title":"Am J Dermatopathol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.5826\/dpc.1102a24","article-title":"Little patients, big issues: something about rapidly growing nodular spitzoid lesions in childhood","volume":"11","author":"Marafioti","year":"2021","journal-title":"Dermatol Pract Concept"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.abd.2020.07.014","article-title":"Recurrence of melanoma in the scar after excised Spitz nevus in a 17-year-old child","volume":"96","author":"Pogorzelska-Dyrbu\u015b","year":"2021","journal-title":"Bras Dermatol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1097\/DAD.0000000000003039","article-title":"A stranger in the slide: A rare collision of a spitz melanocytoma with a novel MYH9::LTK fusion and a common BRAF mutated nevus mimicking a melanoma with a preexistent nevus","volume":"47","author":"Meijs-Hermanns","year":"2025","journal-title":"Am J Dermatopathol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.691017","article-title":"Case report: differential genomics and evolution of a meningeal melanoma treated with ipilimumab and nivolumab","volume":"11","author":"Burgos","year":"2022","journal-title":"Front Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1097\/DAD.0000000000002936","article-title":"Melanoma with RNF11::BRAF fusion: A novel fusion previously undescribed in melanoma","volume":"47","author":"Gao","year":"2025","journal-title":"Am J Dermatopathol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"4026","DOI":"10.3390\/cancers15164026","article-title":"BRAF mutations in melanoma: biological aspects, therapeutic implications, and circulating biomarkers","volume":"15","author":"Castellani","year":"2023","journal-title":"Cancers (Basel)"},{"key":"B26","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1016\/j.pathol.2022.12.001","article-title":"An update on genomic aberrations in Spitz naevi and tumours","volume":"55","author":"Hagstrom","year":"2023","journal-title":"Pathology"},{"key":"B27","article-title":"NRAS and BRAF mutations arise early during melanoma pathogenesis and are preserved throughout tumor progression","volume":"9","author":"Omholt","year":"2003","journal-title":"Clin Cancer Res"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/6300329","article-title":"TERT promoter mutations and telomerase in melanoma","volume":"6300329","author":"Guo","year":"2022","journal-title":"J Oncol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"507516","DOI":"10.1159\/000518219","article-title":"TERT promoter mutational status in the management of cutaneous melanoma: comparison with sentinel lymph node biopsy [J","volume":"238","author":"Martins","year":"2022","journal-title":"Dermatology"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.2007.055376","article-title":"CDKN2A mutations and melanoma risk in the Icelandic population","volume":"45","author":"Goldstein","year":"2008","journal-title":"J Med Genet"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2021.06.002","article-title":"Spitz nevus: review and update","volume":"48","author":"Brown","year":"2021","journal-title":"Clin Plast Surg"},{"key":"B32","doi-asserted-by":"publisher","first-page":"4652","DOI":"10.3390\/cancers14194652","article-title":"Melanoma management: from epidemiology to treatment and latest advances","volume":"14","author":"Lopes","year":"2022","journal-title":"Cancers (Basel)"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1007\/s10585-023-10254-2","article-title":"Sentinel lymph nodes in melanoma: necessary as ever for optimal treatment","volume":"41","author":"Faries","year":"2024","journal-title":"Clin Exp Metastasis"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2019.00231","article-title":"The role and necessity of sentinel lymph node biopsy for invasive melanoma","volume":"6","author":"Nakamura","year":"2019","journal-title":"Front Med (Lausanne)"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.3390\/medicina58111589","article-title":"Sentinel lymph node biopsy in cutaneous melanoma, a clinical point of view","volume":"58","author":"Br\u0103ni\u015fteanu","year":"2022","journal-title":"Med (Kaunas)"},{"key":"B36","doi-asserted-by":"publisher","first-page":"433","DOI":"10.4081\/oncol.2019.433","article-title":"Evolving management of positive regional lymph nodes in melanoma: Past, present and future directions","volume":"13","author":"Fayne","year":"2019","journal-title":"Oncol Rev"},{"key":"B37","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1200\/JCO.2017.75.7724","article-title":"Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: American society of clinical oncology and society of surgical oncology clinical practice guideline update","volume":"36","author":"Wong","year":"2018","journal-title":"J Clin Oncol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2012-0309","article-title":"Lower-limb drainage mapping for lymphedema risk reduction after pelvic lymphadenectomy for endometrial cancer","volume":"18","author":"Bats","year":"2013","journal-title":"Oncologist"},{"key":"B39","doi-asserted-by":"publisher","first-page":"5544","DOI":"10.3390\/jcm10235544","article-title":"Analysis of the different lymphatic drainage patterns during sentinel lymph node biopsy for skin melanoma","volume":"10","author":"Cirocchi","year":"2021","journal-title":"J Clin Med"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11042-023-14418-w","article-title":"A vision-based real-time traffic flow monitoring system for road intersections","author":"Azimjonov","year":"2023","journal-title":"Multimed Tools Appl"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.5146\/tjpath.2010.01047","article-title":"The importance of consumption of the epidermis in Malignant melanoma and correlation with clinicopathological prognostic parameters","volume":"27","author":"Se\u00e7kin","year":"2011","journal-title":"Turk Patoloji Derg"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2022.807049","article-title":"Development and psychometric evaluation of family caregivers\u2019 Hardiness scale: A sequential-exploratory mixed-method study","volume":"13","author":"Hosseini","year":"2022","journal-title":"Front Psychol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.17349","article-title":"Multiple primary Malignancies in head and neck cancer: A university hospital experience over a five-year period","volume":"13","author":"Batista","year":"2021","journal-title":"Cureus"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2404139","article-title":"Final results for adjuvant dabrafenib plus trametinib in stage III melanoma","volume":"391","author":"Long","year":"2024","journal-title":"N Engl J Med"},{"key":"B45","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/s12913-023-09058-7","article-title":"Cost-effectiveness of immune checkpoint inhibition and targeted treatment in combination as adjuvant treatment of patient with BRAF-mutant advanced melanoma","volume":"23","author":"Li","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"B46","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1007\/s11864-025-01370-0","article-title":"Cost-effectiveness of current therapeutic strategies for melanoma","volume":"27","author":"Goto","year":"2025","journal-title":"Curr Treat Options Oncol"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.70084","article-title":"Overall side-effect bother consistently associated with early treatment discontinuation due to adverse events in four clinical trials with various cancer types and treatments","author":"Peipert","year":"2025","journal-title":"Cancer"},{"key":"B48","doi-asserted-by":"publisher","first-page":"105813","DOI":"10.5306\/wjco.v16.i6.105813","article-title":"Clinical characteristics and prognostic factors in patients with Malignant melanoma: A Chinese prospective cohort study","volume":"16","author":"Tang","year":"2025","journal-title":"World J Clin Oncol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1709633\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T06:34:16Z","timestamp":1771310056000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1709633\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,17]]},"references-count":48,"alternative-id":["10.3389\/fimmu.2026.1709633"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1709633","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,17]]},"article-number":"1709633"}}