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Spitz nevus

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Spitz nevus
Spitz nevus

A Spitz nevus is a benign melanocytic tumor, meaning a skin lesion originating from pigment-producing cells called melanocytes. It most commonly occurs in children and adolescents, and less frequently in adults. Clinically, it can resemble malignant melanoma, which makes it a lesion requiring particular diagnostic vigilance. Histopathologically, it is characterized by the presence of large, spindle-shaped or epithelioid melanocytes with abundant cytoplasm. Although it is benign in most cases, due to potential difficulties in differentiating it from melanoma, any suspicious lesion of this type requires dermatological consultation and often surgical removal followed by histopathological examination.

Spitz nevus – what does it look like?

The clinical picture of a Spitz nevus can be characteristic, although not uniform. It is most commonly:

  • a smooth, dome-shaped nodule,
  • well-demarcated from the surrounding skin,
  • usually up to 1 cm in diameter,
  • with color:
    • pink, red, or skin-colored (so-called non-pigmented form),
    • less commonly brown or black (pigmented form).

Typical features:

  • rapid growth over a few weeks or months,
  • single lesion,
  • mainly located on the face and lower extremities in children,
  • more commonly on the trunk in adults.

In dermoscopy, the following may be visible:

  • symmetrical arrangement of structures,
  • radiating streaks (so-called starburst pattern),
  • homogeneous vascular structure in the form of dots or commas.

The diagnostic challenge is that some Spitz nevi – especially in adults – can clinically and dermoscopically mimic melanoma. Therefore, rapid growth, asymmetry, irregular borders, or change in color require urgent diagnostic evaluation.

Spitz nevus – is it dangerous?

In its classic form, a Spitz nevus is a benign lesion. It does not tend to metastasize or aggressively infiltrate tissues. However, its "threat" arises from several significant aspects:

  1. Similarity to melanoma – both clinically and histopathologically.
  2. The existence of lesions with an ambiguous biological nature, referred to as:
    • atypical Spitz tumors (AST – Atypical Spitz Tumor),
    • spitzoid melanomas.

In adults, any newly formed, rapidly growing melanocytic lesion should be approached with more caution than in children.

Factors requiring special vigilance:

  • appearance of the lesion after the age of 30,
  • diameter over 1 cm,
  • ulceration,
  • bleeding,
  • irregular borders,
  • asymmetry.

In clinical practice, the rule is: every suspicious Spitz-type lesion should be excised and histopathologically evaluated, because only microscopic examination can definitively determine the nature of the lesion.

Spitz Nevus – Is It Cancer?

The classic Spitz nevus is not cancer and is not malignant melanoma. It is a benign melanocytic tumor.

However, in the spectrum of spitzoid lesions, three groups are distinguished:

  1. Classic Spitz nevus – benign.
  2. Atypical Spitz tumor (AST) – a lesion with intermediate features, potentially biologically ambiguous.
  3. Spitzoid melanoma – a malignant tumor histologically resembling a Spitz nevus.

Differentiating between these entities can be challenging even for an experienced pathologist. Diagnostic methods include:

  • classic histopathological examination,
  • immunohistochemical studies (e.g., Ki-67, HMB-45),
  • molecular techniques (e.g., FISH, CGH),
  • assessment of genetic mutations (e.g., HRAS, BRAF, ALK).

In contrast to melanoma, a classic Spitz nevus:

  • is symmetrical,
  • shows maturation of cells deeper into the dermis,
  • does not show deep, atypical cellular divisions.

In summary: not every Spitz nevus is cancer, but every lesion with such an appearance should be taken seriously diagnostically.

Spitz nevus - treatment

Treatment strategy depends on the patient's age, the location of the lesion, and its clinical and dermatoscopic appearance.

1. Surgical Excision

The standard procedure is:

  • complete excision of the lesion with a margin of healthy tissue,
  • sending the specimen for histopathological examination.

The excision margin usually measures:

  • 1–2 mm for suspected benign nevi,
  • wider margin for ambiguous results.

2. Observation (selected cases in children)

In certain situations, close observation is possible for young children with a typical clinical and dermatoscopic appearance. However, in clinical practice, excising the lesion is increasingly preferred for diagnostic safety.

3. Management of Atypical Lesions

In the case of diagnosis of:

  • an atypical Spitz tumor – margin widening may be possible,
  • spitzoid melanoma – melanoma treatment standards are applied (widening margins, possibly sentinel lymph node biopsy).
Spitz Nevus – Importance of Dermatological Examination

Every new, rapidly growing pigmented lesion – especially in adults – requires:

  • dermatoscopic examination,
  • photographic documentation,
  • possible qualification for excision.

Regular dermatological check-ups allow for:

  • early detection of melanoma,
  • differentiation of melanocytic lesions,
  • safe monitoring of atypical moles.

In the case of pigmented lesions, it is crucial that the decision on the method of management is made by a dermatologist or oncological surgeon, based on current standards of dermato-oncological diagnostics.

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