key: cord-0812497-guuiaaf9
authors: Martin-Gorgojo, A.; Ramírez-Bellver, J.L.; Ruiz-Rodríguez, R.; Pizarro, Á.
title: SARS-CoV-2 Spike-like Pigmented Peripheral Structures: A Dermoscopic Finding in Dysplastic Nevi and Incipient Melanomas()
date: 2021-11-10
journal: Actas Dermosifiliogr
DOI: 10.1016/j.adengl.2021.11.002
sha: bbc2c980f0f0d6478b5abe793b6f3ed821ab3ba2
doc_id: 812497
cord_uid: guuiaaf9

nan

The journal Nature recently published an article featuring an image (Fig. 1 ) that immediately caught our attention. If the image was shown in a Rorschach test, a virologist would probably say "coronavirus", but a dermatologist trained in dermoscopy might well say "a growing melanocytic nevus" or even "melanoma". Several aspects of the image reminded us of dermoscopic features we have seen in dysplastic melanocytic nevi and incipient melanomas (Fig. 2) .

Dermoscopy reveals markedly irregular, large polymorphous peripheral structures, often long in shape and with an angulated rim, similar to the spike proteins of the virus particle in the electron micrograph in Fig. 1 . These features are indicative of a growing atypical melanocytic lesion (dysplastic nevus or incipient melanoma).

Zalaudek et al. 2 described the presence and significance of peripheral globules in melanocytic lesions a number of years ago. These globules, which frequently project outwards from the silhouette of the lesion, and sometimes appear to be disconnected, usually indicate active growth. 3, 4 Many expanding junctional or compound nevi have a peripheral rim of pigmented globules, which are also common in the most active growth phase of Spitz or Reed nevi. 5 Reiter et al. 6 did not include lesions with pseudopods in their study. While pseudopods are also round or oval structures that project outwards from the edge of lesions, they are not globules in the strict sense of the word (the Spanish equivalent is defined as "a small spherical body" in the latest edition of the Royal Spanish Academy dictionary). Similarly, we do not believe that the structures shown in Fig. 2 -long, polymorphous, pigmented structures, some with an angulated rim-can be described as peripheral globules. Strictly speaking thus, they should not be called globules, nor attributed the same biologic or diagnostic significance as classic peripheral pigmented globules in melanocytic lesions. [2] [3] [4] [5] In our experience, these highly irregular pigmented peripheral structures are rare and are neither globules nor pseudopods. We have recently seen several cases of severely dysplastic melanocytic nevi and incipient melanomas whose most distinctive and suspicious structural characteristic was a peripheral ring (sometimes incomplete) featuring structures of this type (Fig. 2) .

In light of the electron micrograph shown in Fig. 1 and the fact that we first observed these dermoscopic features during the COVID-19 pandemic, we have decided to call them SARS-CoV-2 spike-like pigmented peripheral structures. We believe that the morphologic similarities between the viral spike proteins and these structures are clearly depicted in Figs. 1 and 2 . We do not believe that their biologic significance or diagnostic value should be likened to those of classic pigmented peripheral globules, although systematic studies are needed to examine more cases. 

COVID and 2020: An extraordinary year for science

Using dermoscopic criteria and patient-related factors for the management of pigmented melanocytic nevi

Growth-curve modeling of nevi with a peripheral globular pattern

Frequency and characteristics of enlarging common melanocytic nevi

Spitz nevi: a bridge between dermoscopic morphology and histopathology

Association between the dermoscopic morphology of peripheral globules and melanocytic lesion diagnosis

Figura 2: Imágenes de dermatoscopia con luz polarizada

Lesiones con estructuras pigmentadas periféricas de tamaño grande y morfología irregular, similares a las espículas del virus SARS-CoV-2. Bajo cada uno de los paneles se observa detalle de una zona (A y C: esquina inferior derecha de las lesiones

Diagnósticos histopatológicos: A. Nevo displásico. C. Melanoma in situ. D. Melanoma de extensión superficial

The authors declare that they have no conflicts of interest in relation to the content of this article.