The stars within the melanocytic garden: unusual variants of Spitz naevi

Moscarella, Elvira; Jalbout, Samer Al; Piana, Simonetta; Argenziano, Giuseppe; Lallas, Aimilios; Longo, Caterina; Hofmann‐Wellenhof, Rainer; Zalaudek, Iris

doi:10.1111/bjd.13347

Cited by 17 publications

(16 citation statements)

References 24 publications

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“…Several infrequent dermoscopic patterns have been also reported in Spitz naevi and suggested to correspond to peculiar histopathological variants such as angiomatoid or desmoplastic Spitz naevus …”

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confidence: 94%

“…13,16 Several infrequent dermoscopic patterns have been also reported in Spitz naevi and suggested to correspond to peculiar histopathological variants such as angiomatoid or desmoplastic Spitz naevus. 17 Although dermoscopy provided further insights into the morphology of Spitz naevus, management of spitzoid lesions remains controversial. The main source of controversy is the fact that spitzoid melanoma might perfectly mimic a Spitz naevus, displaying one of the aforementioned dermoscopic patterns.…”

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confidence: 99%

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Update on dermoscopy of Spitz/Reed naevi and management guidelines by the International Dermoscopy Society

et al. 2017

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Spitzoid lesions represent a challenging and controversial group of tumours, in terms of clinical recognition, biological behaviour and management strategies. Although Spitz naevi are considered benign tumours, their clinical and dermoscopic morphological overlap with spitzoid melanoma renders the management of spitzoid lesions particularly difficult. The controversy deepens because of the existence of tumours that cannot be safely histopathologically diagnosed as naevi or melanomas (atypical Spitz tumours). The dual objective of the present study was to provide an updated classification on dermoscopy of Spitz naevi, and management recommendations of spitzoid-looking lesions based on a consensus among experts in the field. After a detailed search of the literature for eligible studies, a data synthesis was performed from 15 studies on dermoscopy of Spitz naevi. Dermoscopically, Spitz naevi are typified by three main patterns: starburst pattern (51%), a pattern of regularly distributed dotted vessels (19%) and globular pattern with reticular depigmentation (17%). A consensus-based algorithm for the management of spitzoid lesions is proposed. According to it, dermoscopically asymmetric lesions with spitzoid features (both flat/raised and nodular) should be excised to rule out melanoma. Dermoscopically symmetric spitzoid nodules should also be excised or closely monitored, irrespective of age, to rule out atypical Spitz tumours. Dermoscopically symmetric, flat spitzoid lesions should be managed according to the age of the patient. Finally, the histopathological diagnosis of atypical Spitz tumour should warrant wide excision but not a sentinel lymph-node biopsy.

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confidence: 94%

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confidence: 99%

Update on dermoscopy of Spitz/Reed naevi and management guidelines by the International Dermoscopy Society

et al. 2017

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“…Spitz nevi are congenital or acquired nevi observed in children and adults, macroscopically presenting as either dark brown/black or pink flat/slightly elevated lesions with preferred location on the face, limbs or buttocks . The terminology and classification of starburst nevi is confusing as they may present with a wide spectrum of morphologies . On the one hand, the distinction between benign and malign spitzoid melanocytic lesions is often problematic; on the other hand, Spitz nevi are sometimes clinically mistaken for benign non‐melanocytic lesions like hemangioma or dermatofibroma .…”

Section: Spitz Nevimentioning

confidence: 99%

“…The term “pigmented Spitz–Reed nevus” was established for lesions in which interobserver disagreement regarding definition as a pigmented Spitz nevus or a Reed nevus occurred, as these two entities show overlapping features . Other seldom variants of Spitz nevi are verrucous and angiomatoid Spitz nevi . As they could not find close correlations between dermoscopic patterns and histopathological categories of pigmented Spitz nevi and Reed nevi, Ferrara et al .…”

Section: Spitz Nevimentioning

confidence: 99%

“…2 The terminology and classification of starburst nevi is confusing as they may present with a wide spectrum of morphologies. 15 On the one hand, the distinction between benign and malign spitzoid melanocytic lesions is often problematic; on the other hand, Spitz nevi are sometimes clinically mistaken for benign non-melanocytic lesions like hemangioma or dermatofibroma. 16,17 Dr Spitz primarily described these lesions as "melanoma of childhood", while Reed et al described a heavily pigmented melanocytic nevus commonly found on the lower extremities of young adolescents, which led to their immortalization in the terms "Spitz nevus" and "Reed nevus", today also used as a synonym for starburst nevi.…”

Section: Spitz Nevimentioning

confidence: 99%

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Abundance of the benign melanocytic universe: Dermoscopic–histopathological correlation in nevi

Woltsche

Schmid‐Zalaudek

Deinlein

et al. 2017

The Journal of Dermatology

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The broad universe of "melanocytic nevi" includes a variety of different subtypes, which can be classified either due to their morphology, epidemiology, genetic alterations or risk for developing melanoma. Regarding morphology, on the one hand macroscopic/clinical and on the other hand histopathological appearance were used to subdivide in the past, often resulting in confusion and poor interobserver agreement, while nowadays dermoscopy presents the clinician's precious bridge between naked-eye examination and histopathological diagnostics, allowing prediction of the lesions' histopathology, follow up and monitoring over time without need of excision. The non-invasive dermoscopic examination relies on the assessment of colors, patterns and the distribution of both within a cutaneous lesion. Until today, the correspondence of certain dermoscopic colors and patterns to certain histopathological correlates has been reported for a huge amount of different cutaneous lesions. Moreover, the correspondence of certain dermoscopic features to certain body sites, age groups and pigmentary traits, but also to specific genetic alterations in lesions, has been broadly investigated. Dermoscopy has led us to a new understanding of melanocytic nevi's biology and evolution and, last but not least, to a new classification system, which we want to present herein.

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Dermoscopy of Melanocytic Lesions in the Paediatric Population

Marino¹,

DeFazio²,

Braun³

et al. 2019

Harper's Textbook of Pediatric Dermatology

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The stars within the melanocytic garden: unusual variants of Spitz naevi

Abstract: In all cases an atypical melanocytic lesion could not be excluded under dermoscopy, thus warranting excision and histopathological examination.

Cited by 17 publications

References 24 publications

Update on dermoscopy of Spitz/Reed naevi and management guidelines by the International Dermoscopy Society

Update on dermoscopy of Spitz/Reed naevi and management guidelines by the International Dermoscopy Society

Abundance of the benign melanocytic universe: Dermoscopic–histopathological correlation in nevi

Dermoscopy of Melanocytic Lesions in the Paediatric Population

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