Key clinical, dermatoscopic and microscopic findings in the diagnosis and management of Spitz nevus

Abstract

Spitz nevus (NS) is a benign melanocytic neoplasm that occurs most commonly in Caucasian children and young people. Its etiopathogenesis is unknown, but it has been associated with genetic, hormonal, immunological and environmental factors. Clinically, it manifests as a well-defined, symmetrical, dome-shaped papule of firm consistency, small size, and variable color (flesh, pink, red or brown) that is most frequently located on the head, neck, and lower extremities. Its clinical variants include Reed nevus, desmoplastic NS, polypoid NS, verrucous NS, and multiple NS.         

The broad clinical morphology of NS and its similarities to melanoma make the diagnosis of this entity challenging. The integration of clinical, dermoscopic and histopathological findings makes it possible to distinguish between benign and malignant melanocytic lesions. The most characteristic dermoscopic patterns of NS are the starburst pattern, the globular pattern with reticular depigmentation, and the dotted vessels pattern. Microscopically, classic NS is observed as a symmetrical, well-defined lesion, formed by spindle-shaped melanocytes arranged in vertical nests in the epidermis, with the presence of Kamino bodies, superficial granular pigment, and absence of atypical mitosis.

The management of NS will depend on the risk characteristics of atypical spitzoid lesions or melanoma. Typical NS lesions can receive clinical follow-up, while those that show indeterminate or high malignancy potential should be surgically removed.

A review of the Spitz nevus is presented to identify its clinical presentation, characteristic dermoscopic and histopathological findings, to provide the physician with the necessary tools for proper diagnosis and management to rule out the possibility of malignant melanocytic neoplasms.