From the Guidelines
The recommended treatment for a Spitzoid nevus is complete surgical excision with narrow margins (2-3 mm). This approach allows for both definitive treatment and comprehensive histopathological examination to rule out melanoma. For suspicious lesions, an initial biopsy (shave, punch, or incisional) may be performed first to establish the diagnosis before complete excision. After removal, the specimen should be sent for pathological evaluation to confirm the diagnosis and ensure complete removal. Close follow-up is recommended, typically every 6-12 months, to monitor for any recurrence or development of new lesions. Spitzoid nevi require careful management because they can sometimes be difficult to distinguish from spitzoid melanoma, even for experienced dermatopathologists. These lesions occur most commonly in children and young adults and appear as pink to reddish-brown dome-shaped papules or nodules. While most Spitzoid nevi are benign, their atypical clinical and histological features necessitate complete removal rather than observation, particularly in adults where the risk of melanoma is higher 1.
Key Considerations
- Complete surgical excision with narrow margins (2-3 mm) is the recommended treatment for Spitzoid nevus.
- Initial biopsy may be performed for suspicious lesions to establish the diagnosis before complete excision.
- Close follow-up is essential to monitor for any recurrence or development of new lesions.
- Spitzoid nevi can be difficult to distinguish from spitzoid melanoma, and their atypical features necessitate complete removal rather than observation.
Diagnostic Algorithm
The diagnostic algorithm for atypical spitzoid tumors involves a set of immunohistochemistry assays, FISH with five probes, and a comprehensive array-based comparative genomic hybridization assay 1. This algorithm helps to identify histological features associated with melanoma and provides a more accurate diagnosis. However, the management of Spitzoid nevus remains focused on complete surgical excision and close follow-up, rather than relying solely on the diagnostic algorithm.
Clinical Implications
The clinical implications of Spitzoid nevus are significant, particularly in adults where the risk of melanoma is higher. Complete removal of the lesion and close follow-up are essential to ensure early detection and treatment of any potential melanoma. The use of a diagnostic algorithm can help to identify atypical features and provide a more accurate diagnosis, but it should not replace the standard treatment approach of complete surgical excision and close follow-up 1.
From the Research
Treatment of Spitzoid Nevus
The recommended treatment for a Spitzoid nevus is primarily surgical excision, especially for clinically atypical spitzoid lesions of childhood and all spitzoid lesions of adulthood 2. This approach is due to the difficulties in clinically and histopathologically differentiating between benign and malignant spitzoid neoplasms.
Management Approaches
- Surgical excision is usually reserved for spitzoid lesions with doubtful features 3.
- Clinical and dermoscopic follow-up is preferred for typical pediatric Spitz nevi 3.
- For lesions with atypical features, a variety of management approaches are considered, including total or partial biopsies, and excision with margins of normal-appearing skin around the lesion 4.
- The role of sentinel lymph node biopsy in atypical Spitz tumors is debated, with some studies suggesting it is not necessary 5.
Dermoscopic Patterns and Management
- Spitz nevi can exhibit various dermoscopic patterns, including starburst, globular, and reticular patterns 5.
- A consensus-based algorithm for the management of spitzoid lesions proposes excision for dermoscopically asymmetric lesions with spitzoid features, and close monitoring or excision for symmetric spitzoid nodules 5.
- The management approach may vary depending on the age of the patient and the dermoscopic characteristics of the lesion 5.
Histopathological Diagnosis and Management
- The histopathological diagnosis of atypical Spitz tumor should warrant wide excision, but not a sentinel lymph-node biopsy 5.
- Immunohistochemistry and molecular techniques, such as comparative genomic hybridization and fluorescence in situ hybridization, may offer new diagnostic perspectives for distinguishing between Spitz nevi and melanomas 3, 6.