Spitz Nevus: A Clinicopathological Study of 349 Cases

Abstract

Spitz nevus is an infrequent, usually acquired melanocytic nevus composed of epithelioid and/or spindle melanocytes that can occasionally be confused with melanoma. Currently, there are no immunohistochemical markers or molecular biology techniques that can be used to make an entirely safe diagnosis of Spitz nevus or melanoma in problematic cases. A retrospective study has been carried out that included all the cases diagnosed as Spitz nevus from our files. Follow-up information of the patients was unavailable. Three hundred forty-nine cases of unequivocal Spitz nevi were included, and their clinical and histopathological parameters were reviewed. One hundred and forty patients (40%) were 15 years old or younger, with a male to female ratio of 1:1. In patients older than 15 years, there was an evident predominance of women, with a male to female ratio of around 1:3. Spitz nevus was most commonly located on the lower extremities, followed by the trunk in both children and adults. Despite the fact that the head and neck were the third most common location in children, it was a much more frequent location in children than in adults. The constitution by epithelioid and/or spindled cells was the only histopathological finding present in 100% of cases. The other pathological findings studied were, from more to less frequent: maturation (72%), inflammatory infiltrate (70%), epidermal hyperplasia (66%), melanin (50%), telangiectasias (40%), Kamino bodies (34%), desmoplastic stroma (26%), mitosis (23%), pagetoid extension (13%), and hyalinization of the stroma (8%). Hyalinization was the only histopathological parameter that was statistically more frequent in adults than in children.

Pediatric Atypical Spitzoid Neoplasms: A Review with Emphasis on ‘Red’ (‘Spitz’) Tumors and ‘Blue’ (‘Blitz’) Tumors

“…Along with the original description made by Sophie Spitz in 1948 [10], a ‘classical’ SN is considered as a rapidly growing, pink or flesh-colored papule or nodule of the lower extremities or the face in childhood or early adulthood [11,12]; however, in a recent paper on 349 cases of histopathologically proven SN, only 18.33% of cases were correctly diagnosed on clinical grounds and only 22.1% of pediatric cases had the lesion located on the face [6]. Whether ‘classical’ SN is really uncommon or simply uncommonly excised can be debated: there is no doubt, however, that a ‘new’ clinicopathologic stereotype of SN is emerging, probably thanks to dermoscopy [1,2].…”

“…Whether ‘classical’ SN is really uncommon or simply uncommonly excised can be debated: there is no doubt, however, that a ‘new’ clinicopathologic stereotype of SN is emerging, probably thanks to dermoscopy [1,2]. The start point is that heavily pigmented SN [3] and Reed nevus [13] show largely overlapping clinicopathologic features [1,2,6]. If so, we have to conclude that small to medium-sized tan-black macules and plaques account for the large majority of excised SN (79.5% in our previous study [1]); dermoscopically, these lesions can be typified by 5 patterns (globular, starburst, reticular, atypical and homogeneous) [1,14] which can simply represent different evolution phases of SN [15]; the most common among these patterns are the globular, starburst and atypical ones [1].…”

“…Before dermoscopy, Spitz nevus (SN) could be mainly identified by clinicians as a pink to red papulonodular lesion of the face and the extremities of children. With the advent of dermoscopy, it has become evident that, by lumping together pigmented spindle cell SN and Reed nevus [3,4,5,6], most histopathologically benign spitzoid neoplasms can be clinically recognized as tan to black plaques with 3 main dermoscopic patterns, namely starburst, globular and multicomponent (atypical, melanoma-like) [1,2]. Such a high frequency of pigmented variants among excised lesions could be the result of their better clinical recognition due to dermoscopy, coupled with a low excision rate of classical ‘pink-red’ SN in children.…”

Acral Pigmented Spitz Nevus That Clinically Mimicked Acral Lentiginous Malignant Melanoma

“…Histologically, Spitz nevus is more likely to contain melanin when a junctional component is present, and especially if there is no additional dermal component. The distribution of melanin is a valuable criterion for making the differential diagnosis between Spitz nevus and melanoma because when it presents, its distribution is almost always regular and superficial in Spitz nevus, whereas it is irregular and/or bottom heavy in spitzoid melanoma 12 . A junctional component was present in this present case.…”

Nevo de Spitz: relato de caso e dermatoscopia

“…It is formed of large melanocytes, sometimes with nuclear atypia and abundant, rounded, oval, fusiform and polygonal cytoplasm with a fusiform and epithelioid appearance, arranged in nests. 5,6 CASE REPORT BISG, a two-year old girl with skin phototype 2, living in the Federal District of Brazil. According to her mother, the child had a "mark" that grew in size and bled spontaneously.…”