Rosette-like formations in melanocytic neoplasms: A case report and literature review

Homer-Wright-like rosettes are a common finding in neural tumors but seldom seen in melanocytic nevi and melanoma. We report a case of a 23-year-old male with a compound melanocytic nevus with such rosette-like structures and summarize the current literature on this histopathological feature in melanocytic neoplasms. A symmetric, well-circumscribed, compound nevus consisting of aggregations of epithelioid melanocytes with eccentric nuclei and central eosinophilic cytoplasm, resembling Homer-Wright rosettes, was present on biopsy. Immunohistochemical stains strongly supported a melanocytic entity and were negative for NTRK1/2/3, a fusion protein potentially associated with rosette-like structures. We found 17 other cases of benign melanocytic nevi, including 9 atypical Spitz tumors and 6 Spitz nevi, and 11 malignant melanomas, including 3 Spitz melanomas and 4 metastases. We observed remarkable diversity among lesion morphologies containing rosettes, as well as level of prominence and cytology of the rosettes themselves. This case illustrates the morphologic malleability of neural-crest-derived lesions to share microscopic and phenotypic attributes.