Spitz Nevus

Updated: Mar 24, 2017
  • Author: Zoltan Trizna, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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Overview

Background

Physicians have known for almost a century that some childhood lesions histologically diagnosed as melanomas did not show malignant behavior. The terms juvenile melanoma and prepubertal melanoma were used to describe such lesions.

Several attempts were made to establish objective criteria that would clearly delineate Spitz nevi and melanomas. The controversial classification of some cases as metastasizing Spitz nevi further confounded the issue; however, such cases illustrate the difficulty of accurately distinguishing some Spitz nevi from melanoma based on histological criteria alone. Even today, no set of criteria can be used to predict the clinical outcome of atypical Spitz tumors with absolute assurance.

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Pathophysiology

A Spitz nevus can arise de novo or in association with an existing melanocytic nevus.

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Epidemiology

Frequency

Exact data on incidence or prevalence are not available. Spitz nevi are estimated to represent less than 1% of all childhood melanocytic nevi.

Race

Spitz nevi have been described most frequently in fair-skinned individuals. One study reviewed 130 cases in a Hispanic population, demonstrating that Spitz nevi are not restricted to white patients. [1]

Sex

Both sexes are equally affected. Some authors describe a slight female predominance.

Age

About 50% of cases occur in children younger than 10 years; 70% of all cases are diagnosed during the first 2 decades of life.

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Prognosis

The prognosis is good. Recurrences should be treated with re-excision. These lesions are clinically benign. A 2011 study reporting on 157 patients with Spitz-type melanotic lesions suggests that atypical Spitz tumors pose a minimal threat of mortality but have an increased risk of melanoma and a moderate risk of metastasis to regional nodes. Aggressive treatment is usually not needed, but monitoring for signs of relapse, as well as subsequent melanomas, is recommended. [2]  Mitoses and inflammation are indicators of increased aggressiveness. [3] Using single morphologic features to determine prognosis has severe limitations. [4]

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Patient Education

Educate patients about sun protection and self-examination of the skin. For patient education materials, see the Cancer and Tumors Center.

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