Two compound Spitz nevi (ALK1 and ALK2) demonstrated ALK fusions (TPM3-ALK rearrangement for both lesions) (Table 1) and showed characteristic histomorphology for this category of tumor, i.e., fascicles of spindled melanocytes with plexiform growth pattern, in addition to a dome-shape clinical appearance (Figure 1). Here, ACVR1 is linked to neoplasm.