Update on dermoscopy of Spitz/Reed naevi and management guidelines by the International Dermoscopy Society

Abstract

Spitzoid lesions represent a challenging and controversial group of tumours, in terms of clinical recognition, biological behaviour and management strategies. Although Spitz naevi are considered benign tumours, their clinical and dermoscopic morphological overlap with spitzoid melanoma renders the management of spitzoid lesions particularly difficult. The controversy deepens because of the existence of tumours that cannot be safely histopathologically diagnosed as naevi or melanomas (atypical Spitz tumours). The dual objective of the present study was to provide an updated classification on dermoscopy of Spitz naevi, and management recommendations of spitzoid-looking lesions based on a consensus among experts in the field. After a detailed search of the literature for eligible studies, a data synthesis was performed from 15 studies on dermoscopy of Spitz naevi. Dermoscopically, Spitz naevi are typified by three main patterns: starburst pattern (51%), a pattern of regularly distributed dotted vessels (19%) and globular pattern with reticular depigmentation (17%). A consensus-based algorithm for the management of spitzoid lesions is proposed. According to it, dermoscopically asymmetric lesions with spitzoid features (both flat/raised and nodular) should be excised to rule out melanoma. Dermoscopically symmetric spitzoid nodules should also be excised or closely monitored, irrespective of age, to rule out atypical Spitz tumours. Dermoscopically symmetric, flat spitzoid lesions should be managed according to the age of the patient. Finally, the histopathological diagnosis of atypical Spitz tumour should warrant wide excision but not a sentinel lymph-node biopsy.

The limitations of dermoscopy: false‐positive and false‐negative tumours

“…Spitz and Reed naevus. Three dermoscopic patterns of Spitz and Reed naevi have been thoroughly studied . Reed naevi are typified by the so‐called starburst pattern, consisting of a dark brown/black/blue centre and symmetrically distributed peripheral streaks or pseudopods.…”

“…Non‐pigmented Spitz naevi are typified by the presence of symmetrically distributed vessels (usually dotted) and white spaces among them (inverse network). All the aforementioned patterns are characterized by a symmetric distribution of structures . The same structures (streaks, pseudopods, vessels, inverse network), if not symmetrically distributed, represent melanoma criteria (irregular streaks, irregular pseudopods, atypical vessels etc.)…”

“…The problem of how to manage a spitzoid‐looking lesion gets even more complicated by the fact that spitzoid melanomas perfectly mimicking a symmetric Spitz/Reed naevus do also exist . To address this problem, the International Dermoscopy Society has recently released management guidelines Combined naevus.…”

Patients with Spitz naevi in the Greek population: Epidemiologic, Clinical and Histopathological characteristics

“…As a result, numerous studies have been published on this subject and a double standard when it comes to the management of Spitzoid lesions has been established. While simple follow‐up without therapeutic intervention is usually recommended for children, excision is a more preferred approach in adults . On the other hand, data regarding the possible clinicopathological differences between classic/pigmented Spitz naevi arising at different age groups are very limited.…”

A regressing spindle cell tumour of Reed

“…International guidelines recommend that a flat Reed naevus with symmetrical morphology may be observed until its growth is stabilised or the naevus completely disappeared 3. However, an excision biopsy should be considered if a skin lesion resembling a Reed naevus occurs in adulthood or if there is any concern about the lesion, such as having asymmetrical morphology or growth, or is nodular in nature, in order to rule out atypical Spitzoid tumour or Spitzoid melanoma 3…”