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A classification of spitzoid melanocytic lesions into tumors (without or with atypical features) and melanoma has been recently proposed, thereby underlining the existence of a morphobiologic spectrum of lesions, ranging from benignity to full-blown malignancy. However, only in rare instances are spitzoid lesions clinically tumors (ie, cutaneous elevations [nodules] exceeding the size of a cherry [>2 cm]).
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Dermoscopy has demonstrated that the pigmented (brown-black) variant of Spitz nevus is
Spitz Nevus, Spitz Tumor, and Spitzoid Melanoma: A Comprehensive Clinicopathologic Overview
Section snippets
Key points
A new clinical stereotype of Spitz nevus
A classification of spitzoid lesions into Spitz tumors without atypical features, atypical Spitz tumors, and spitzoid melanoma11 is not easily accepted; nor is it in keeping with existing clinicopathologic terminology, because clinical dermatology literally defines tumors as cutaneous elevations (nodules) exceeding the size of a cherry (ie, generally >2 cm),12, 13 and this is seldom the case for spitzoid lesions.
The increasing use of dermoscopy (dermatoscopy, skin surface microscopy) in the
Atypical Spitz nevus or tumor: does the clinical picture matter?
Once a typical Spitz nevus is redefined, we should define the atypical categories. At present, an unequivocal and reproducible definition for atypical Spitz nevus and (atypical) Spitz tumor is probably lacking. In general, these diagnostic categories can be used for lesions showing some distinctly abnormal characteristics commonly absent in conventional spitzoid lesions.
In 2005, Urso10 performed a review of 19 papers reporting 62 spitzoid neoplasms showing an aggressive biologic behavior
Spitzoid melanoma: lessons from dermoscopy
Ongoing molecular genetic studies on spitzoid neoplasms seem to be a promising diagnostic tool. HRAS mutations and amplifications have been detected in 11.8% of Spitz nevi,30 whereas BRAF and NRAS mutations, which are frequently found in melanoma on skin without chronic sun damage (ie, intermittently sun-exposed sites),31 are rare in Spitz nevi.32 Indeed, when evaluating the reported frequency of BRAF and NRAS mutations, at a first glance it seems that Spitz nevi are different from typical
Guidelines for management
As a general rule, Spitz nevi can be considered as potentially showing all the dermoscopic features of melanoma, but in a more or less regular fashion. However, the occurrence of an atypical dermoscopic pattern in Spitz nevi is well recognized,19 as is the occurrence of melanomas showing very few or no dermoscopic features suggestive of malignancy but exhibiting instead either the globular or the starburst pattern typical of Spitz nevi.39
Based on these considerations, a classical or pigmented
Summary
The introduction of dermoscopy has significantly changed the clinical diorama of spitzoid lesions. Because there are still many controversial points in the histopathologic categorization of these lesions, clinicopathologic correlation must be the mainstay for their diagnosis and proper management.
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Cited by (54)
Multidisciplinary management of a quickly growing pediatric atypical Spitz nevus, mimicking melanoma, during the COVID-19 pandemic
2023, Journal of Pediatric Surgery Case ReportsCitation Excerpt :Additional features of the epidermal component suggestive for melanoma are: asymmetry, poor circumscription, epidermal effusion/consumption, ulceration, enlargement, irregular and confluent nests, pagetoid dispersion. Aberrant morphologic features in the dermal component commonly include: asymmetry, nodular or sheet-like melanocyte aggregates, reduced or absent maturation, deep melanin localization, prominent lymphoid infiltrates, and necrosis [2]. The differential diagnosis includes Spitz nevus, atypical Spitz tumour, and classic melanoma.
Pathology of Melanoma
2020, Surgical Clinics of North AmericaCitation Excerpt :These lesions are grouped together as spitzoid lesions. Most investigators classify the spitzoid lesions into 3 categories—spitz nevus, atypical spitz nevus, and spitzoid melanoma.29,30 The major challenge is to differentiate these lesions.
Dermoscopy: The Essentials
2020, Dermoscopy: The EssentialsDiagnostic Pathology: Pediatric Neoplasms
2018, Diagnostic Pathology: Pediatric NeoplasmsSpecial Clinical Situations
2017, Cutaneous Melanoma: a Pocket Guide for Diagnosis and ManagementDiagnosis of Primary Melanoma
2017, Cutaneous Melanoma: a Pocket Guide for Diagnosis and Management
Funding Sources: None.
Conflicts of Interest: None.