Pediatric Atypical Spitzoid Neoplasms: A Review with Emphasis on ‘Red’ (‘Spitz’) Tumors and ‘Blue’ (‘Blitz’) Tumors

Abstract

Background: The diagnosis of pediatric atypical Spitz nevus/tumors (pASNT) is an emerging challenge in clinical dermatology and dermatopathology. Objective and Methods: We review the main clinicopathologic issues raised by pASNT and describe 2 examples of different clinicopathologic subsets of lesions. Results: While Spitz/Reed nevi are commonly small- to medium-sized, tan to black plaques, pASNT are large and nodular, either ‘red’ (dotted and/or polymorphous vascular pattern on dermoscopy; spindle and/or epithelioid tumors on histopathology: Spitz tumors, sensu strictiori) or ‘blue’ (homogeneous blue color on dermoscopy; intimate admixture of epithelioid cells and heavily pigmented dendritic cells on histopathology: Blitz tumors or pigmented epithelioid melanocytomas). Conclusions: Different clinicopathologic settings of pASNT probably exist. Dermoscopy can aid in their recognition and classification.

Clinical and dermoscopic features of atypical Spitz tumors: A multicenter, retrospective, case-control study

“…We did not investigate either the differential diagnosis with spitzoid melanoma, or non melanocytic lesions, such as angioma and pyogenic granuloma, which can simulate AST both clinically and dermoscopically. 8,10,12,27,28 Further studies are needed to evaluate this differential diagnosis. An additional limitation can be identified in the selection of the study sample, with multicenter collection of AST, whereas SN were selected in a single center.…”

“…10–12 Despite numerous histopathologic studies, few have described the clinical and dermoscopic features of AST. 8,10,12,13 …”

Spitz nevus and Reed nevus

“…The same applies to lesions with a rapid and/or recent change in color, shape and size. 6,7,28,34 With regard to the definition of surgical margins after excisional biopsy with a 1-2 mm margin and histopathological confirmation, there is no agreement in the literature. In the case of atypical lesions, some authors recommend expanding the margin to 1 cm.…”

“…From then on, an annual follow-up is suggested until the complete involution of the lesion. 34 Ferrara et al, in a recent article, suggest that all spitzoid lesions in children, palpable and erythematous, should be excised, especially those larger than 1 cm, nodular, ulcerated and with a rapid evolution with changes in appearance. Excision of lesions in patients older than 12 years of age is also recommended, regardless of the presence of atypical clinical or dermoscopic features ( Figure 12).…”

“…Excision of lesions in patients older than 12 years of age is also recommended, regardless of the presence of atypical clinical or dermoscopic features ( Figure 12). 34 Inadequate histological cuts of atypical lesions that appear asymmetric on clinical and dermoscopic examination my lead to incorrect diagnosis if the region of greatest asymmetry is not represented. Therefore, we suggest that the dermoscopic image be included along with the fragment excised for histopathological examination in order to orient the pathologist to make cuts in areas that are more representative of dermoscopic structures.…”