Scoring System for Evaluating Indications for Wide Excision of Spitz/Reed Nevus in Children and Adolescents

Abstract

This research was aimed to developing the scoring system for evaluating indications for wide excision of the Spitz/Read nevus in children and adolescents, the use of which would be of help in reducing the risk of underdiagnosis of skin melanoma and determining the management tactics of patients with spitzoid formations. The purpose of the research was to create a scoring system for evaluating indications for wide excision of the Spitz/Reed nevus in children and adolescents. Materials and methods used: a single-center (N.N. Petrov National Medical Research Center for Oncology, Saint Petersburg, Russia) retrospective (2016-2022) cohort study included 65 childhood and adolescent patients with skin neoplasms of melanocytic and vascular origin. Clinical and dermatoscopic examinations of the skin neoplasm were performed at the pre-invasive stage, which was then followed by its removal and morphological verification. The study group consisted of children and adolescents aged 0 to 18 y/o (median age 14 (12.0; 15.0) y/o) with complex (n=22 or 33.8%), dermal (n=30/46.1%), blue (n=2/3.1%) nevi, Spitz/Reed nevus (n=4/6.2%) and capillary-lobular hemangioma (n=7/10.8%) Results: correlation analysis of 77 factors characterizing the demographic, clinical and dermatoscopic patterns had allowed the Authors to identify signs that are statistically significantly correlated with the Spitz/Reed nevus variable. In the block with demographic data parameters, the main position was occupied by the patient’s age of over 11 y/o (p˂0.001); formation area ≥0.38 cm2 (p=0.010) topped in the block with clinical examination parameters; and starburst pattern (p=0.003), irregular borders (p˂0.001), white-blue veil (p˂0.001), multicomponent (p=0.001), reticular network (p˂0.001), globules (p˂0.001) and vascular structures in the form of a comma (p˂0.001) among dermatoscopic ones. The value of the prognostic coefficient determined the score of each factor, which contributed to the selection of large and small patterns. The gradation of the sum of scores of the identified predictors made it possible to create a scoring system for analyzing indications for wide excision of the Spitz/Read nevus in children and adolescents and to develop a practical BASE-SCRAG scale. The sensitivity of the scale was 100%, the specificity was 62% (95% CI 57-64%). Conclusions: the Spitz/Reed scoring system for evaluating indications for wide excision of a nevus and the BASE-SCRAG practical scale contribute to the stratification of pediatric and adolescent patients in the group for possible dynamic observation and the group of mandatory removal and verification of the pathological skin process.