Topical Trametinib for Agminated Spitz Nevi Harboring HRAS Mutation

The treatment of agminated Spitz nevi can be challenging due to the potential for disfigurement in cosmetically sensitive areas. We report the case of a pediatric patient with progressive agminated Spitz nevi arising from a nevus spilus  on the face with an associated pathogenic HRAS p.G13R mutation revealed on next-generation sequencing (NGS). The patient was treated with compounded topical trametinib 1% cream and demonstrated significant clinical improvement following 12 weeks of twice-daily treatment. Our case highlights the potential role of MEK inhibition as a targeted, non-surgical treatment for HRAS-mutated agminated Spitz nevi and adds to the growing understanding of their genetic etiology.