The Spitzoid Lesion: The Importance of Atypical Variants and Risk Assessment

Clinical and Histopathology Features of Spitz Nevus: In 22 Cases

“…In our study, inflammatory infiltration was 54.5% predominantly lymphoid cells in nevi which are close to Requena results (5) but it was a little different from others (6). The inflammatory infiltrate which was present in 75% of cases, is consistent with the literature (5,8).…”

“…Maturation of cells within deeper parts of the lesions (cells atrophy and become smaller) and splay between collagen bundles (5). Occasional mitotic illustration may be seen, but are usually located in the superficial dermal component (2,6,7) and intradermal pagetoid melanocytes in the central portion of the lesion which is frequent.…”

The immunohistochemical profile of Spitz nevi and conventional (non-Spitzoid) melanomas: a baseline study

“…Histopathologic examination remains the gold standard to distinguish Spitz nevi from melanoma, albeit no objective criteria exist to predict the biologic behavior of a specific lesion. Earlier, several studies, mostly based on the expression of single or few proteins, have tried to shed light on the eternal controversy surrounding spitzoid lesions, 5,15,22,23 but no markers are yet known to reliably differentiate between the two neoplasms. Thus, neither HMB-45, AgNOR, cyclin D1, c-myc, c-fos, telomerase, cdc-7, anti-leptin receptor, BCL-2, p53 nor p16 proved helpfulness in distinguishing Spitz nevi from melanoma.…”

“…[2][3][4][5] Furthermore, most lesions do not show many of the conventional criteria that are used routinely for the histopathologic diagnosis of the tumor, thus emphasizing the lack of objective criteria for predicting the biologic behavior of such lesions. 3,6,7 The classification of some cases as metastasizing Spitz nevi 1 illustrates the difficulty of accurately distinguishing some Spitz nevi from melanoma based solely on histological criteria.…”

Tertium Non Datur? Legitimacy of a Third Diagnostic Category in Melanocytic Lesions

“…An evident example of this can be found in the case of Spitz tumors, in which forms showing fewer diagnostic features have been considered less biologically aggressive. [18][19][20] In 1999, when such an approach was proposed, experimental evidence was not provided; it remained for future studies to clarify the problem. 19 However, some years later, the equivalence between morphology and biology was stated, [20][21] neglecting that in the intervening time evidence of such equivalence had not been obtained.…”