Continuing medical educationSpitz nevi and other Spitzoid lesions: Part I. Background and diagnoses
Section snippets
Brief history
Key points The landmark publication on Spitz nevi occurred when Sophie Spitz described pediatric lesions that had features of melanoma Recent opinion has been trending toward emphasizing the benign nature of Spitz nevi Refinement of clinical and histologic subtypes within the Spitz family of lesions has led to a highly complex classification of Spitz tumors
Although cases of perplexing melanocytic lesions have been reported in children as early as a century ago,1, 2 the landmark publication for Spitz lesions
Clinical features
Key points Younger age is associated with more likely benign behaving Spitz nevus
Table I offers a comparison of various clinical features suggestive of typical Spitz nevi versus ASTs. Greater attributes from the latter group calls for closer scrutiny to rule out melanoma.
Histopathology
Key points Classic Spitz nevi feature neat organizational attributes, such as symmetry, maturation, distinct margins, small size, and more often show epidermal hyperplasia, Kamino bodies, and junctional clefting Ulceration, significant Breslow thickness, an increased number of mitotic figures, and deep and atypical mitotic figures may be associated with metastatic behavior Most histopathologic criteria remain poorly predictive in cases that overlap between atypical Spitz tumors and melanoma
The available
Additional tests
Key points In common Spitz nevus compared to melanoma, Ki-67 is stained in fewer cells, HMB-45 exhibits differential staining at certain lesion depths, and S100-A6 is stained strongly and diffusely Cytogenetic techniques reveal amplifications in chromosome 11p in a minority of Spitz nevi Most Spitz nevi exhibit a distinct mutation profile from common nevi and melanoma, featuring more HRAS rather than BRAF or NRAS mutations
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Expression Patterns of microRNAs and Associated Target Genes in Ulcerated Primary Cutaneous Melanoma
2023, Journal of Investigative DermatologyCitation Excerpt :For miR-363-3p, increased expression was also shown by our group in melanocytic Spitz tumors relative to that in benign nevi (Latchana et al., 2016). This is notable because ulceration of Spitz nevi can be associated with increased malignant and metastatic behavior (Luo et al., 2011). miR-363-3p is predicted to regulate the expression of CTNNB1, an mRNA that was downregulated in ulcerated tumors (P = 0.0046).
Pigmentary disorders
2021, Pediatric DermatologyVerrucous Spitz Nevus
2020, Journal of PediatricsCells to Surgery Quiz: August 2020
2020, Journal of Investigative Dermatology
Supported by a grant from the American Medical Association (Dr Luo), the National Institutes of Health (K24 CA149202-01 to Dr Tsao), the American Cancer Society (RSG MGO-112970 to Dr Tsao) and generous donors to the MGH Millennium Melanoma Fund.