Can a spitz nevus (benign melanocytic lesion) in children appear pale and dome-shaped?

Spitz Nevus in Children: Clinical Appearance

Spitz nevi in children typically present as red, pink, or dome-shaped papules or nodules, though they can occasionally appear pale or flesh-colored, particularly as they evolve into the intradermal type. 1

Clinical Characteristics of Spitz Nevi

Spitz nevi demonstrate several distinctive features in the pediatric population:

• Typical appearance:

  • Dome-shaped or papular lesions 2, 1
  • Size ranging from 3-15 mm 2
  • Most commonly red or pink in color 1
  • Can also appear in various colors including yellow, brown, purple, and black 2
  • May occasionally present as pale or flesh-colored, especially in the intradermal variant 3

• Location and distribution:

  • Most commonly found on the face and extremities 2, 4
  • Can occur as solitary lesions (most common) or multiple lesions (agminated or disseminated) 2, 5

• Growth pattern:

  • Can develop suddenly and grow rapidly, reaching 1 cm in diameter within 6 months 1
  • Often hairless 2

Histological Classification

Spitz nevi are histologically classified into three types based on the location of melanocytes:

• Junctional
• Compound
• Intradermal 2

The intradermal variant tends to have a more dome-shaped or papular appearance and may be flesh-colored or light brown, resembling common intradermal nevi 3.

Diagnostic Considerations

Distinguishing Spitz nevi from melanoma can be challenging, particularly in atypical presentations:

• Key diagnostic features of benign Spitz nevi:

  • Patient age (more common in children and young adults) 6
  • Sharp demarcation 6
  • Symmetry 6
  • Maturation of melanocytes at the base 6
  • Epithelial hyperplasia 6

• Warning signs requiring further evaluation:

  • Changes in size, color, shape
  • Symptoms such as bleeding, itching, or pain 3
  • Asymmetry
  • Lack of circumscription
  • Ulceration 7

Management Approach

For typical Spitz nevi in children:

• Clinical and dermoscopic follow-up is often preferred 4
• Visual inspection, palpation, and dermoscopic evaluation are essential components of examination 3

For atypical presentations or concerning features:

• Surgical excision with clear margins is recommended 6, 4
• Histopathological examination is necessary for definitive diagnosis 7

Important Considerations

• While classic Spitz nevi are typically red or pink, the appearance can vary considerably, including pale or flesh-colored variants, especially as they evolve into the intradermal type
• Rare variants such as agminated Spitz nevi can present as multiple dome-shaped, red papules on hypopigmented skin 5
• New molecular and immunohistochemical techniques are increasingly used to differentiate difficult cases 4, 7

The dome-shaped morphology is a classic feature of Spitz nevi, but the color can range from pink/red to pale/flesh-colored, particularly in the intradermal variant. Any atypical features should prompt further evaluation to rule out melanoma.