Spitz nevi are benign melanocytic lesions characterized by the presence of large epithelioid or spindle-shaped melanocytes on histopathology.
Many clinical variants of Spitz nevi exist, including pigmented spindle cell nevus of Reed, desmoplastic Spitz nevus, and BAPoma.
Dermoscopic and reflectance confocal microscopy features can assist with a diagnosis of Spitz nevi.
Spitz nevi can have overlapping histopathological features with melanoma, and therefore evaluation by a dermatopathologist with experience in examining these lesions is critical.
Spitz nevi are benign and do not require reexcision when biopsied.
The term atypical Spitz nevus should be reserved for lesions of intermediate phenotype, where reexcision would be appropriate.
Given that Spitz nevi more commonly occur in children, there should be a lower threshold for biopsy of Spitzoid lesions in postpubescent patients to rule out Spitz melanoma.
Clinical features that should raise concern, regardless of the age of the patient, include large size (>1 cm), ulceration, and rapid change.
PATIENT EDUCATION POINTS
Patients should be taught that routine monitoring of histopathologically confirmed Spitz nevi is not recommended, as they are by definition benign.
A lesion that is suspected to be a Spitz nevus, but has not yet been biopsied, should be rechecked every 3 to every 12 months, depending on the clinician’s level of concern. Patients should be instructed to return to the clinic promptly if they notice the lesion to have changed, and biopsy should be considered.
Spitz nevi are benign melanocytic lesions characterized by the presence of large epithelioid or spindle-shaped melanocytes on histopathology. Clinically, they typically present in children as smooth, firm papules that are either pink, red, or brown in color. Unique dermoscopic and reflectance confocal microscopy features can assist with diagnosis. There are several established variants of Spitz nevi, and these lesions are of particular diagnostic relevance because of their overlapping histopathological features with melanoma. Therefore, evaluation by a dermatopathologist with experience in examining these lesions is critical. Spitz nevi are benign and do not require reexcision when biopsied.1 Spitz melanoma is distinguished from its benign counterpart by various histopathological and molecular criteria and, unlike conventional melanoma, is not prognosticated by sentinel lymph node staging.2-4 The terminology for lesions of unknown biologic potential varies and includes atypical Spitz nevus and atypical Spitz tumor. With such lesions, excision is recommended, and a sentinel lymph node biopsy may be performed depending on a variety of factors such as molecular studies.
Classic Spitz nevi typically present as asymptomatic, solitary, firm, smooth papules that are red/pink or skin-colored and measure less than 1 cm in diameter (Figure 9-1). Spitz nevi occur anywhere on the body, but there is a predilection for the face and extremities.5...