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

https://doi.org/10.1016/j.jaad.2015.08.018Get rights and content

Background

Few studies have described the clinical and dermoscopic features of atypical Spitz tumors.

Objective

We sought to describe the clinical and dermoscopic features of a series of atypical Spitz tumors as compared with those of conventional Spitz nevi.

Methods

This was a multicenter, retrospective, case-control study, analyzing the clinical and dermoscopic characteristics of 55 atypical Spitz tumors and 110 Spitz nevi that were excised and diagnosed histopathologically.

Results

The majority of atypical Spitz tumors presented clinically as a plaque or nodule, dermoscopically typified by a multicomponent or nonspecific pattern. A proportion of lesions (16.4%) exhibited the typical nonpigmented Spitzoid pattern of dotted vessels and white lines under dermoscopy. Nodularity, ulceration, linear vessels, polymorphic vessels, white lines, and blue-white veil were associated with atypical Spitz tumors by univariate analysis, but only nodularity and white lines remained significant after multivariate analysis. In contrast, a pigmented typical Spitzoid pattern was a potent predictor of Spitz nevi, associated with 6.5-fold increased probability.

Limitations

Differentiation from Spitzoid melanoma and other nonmelanocytic lesions was not investigated.

Conclusion

Atypical Spitz tumors are polymorphic melanocytic proliferations with a nodular clinical appearance. Dermoscopically they demonstrate a multicomponent and nonspecific pattern. A typical nonpigmented Spitzoid pattern on dermoscopy (with dotted vessels and white lines) does not exclude atypical Spitz tumors.

Section snippets

Methods

We conducted a multicenter, case-control study analyzing clinical and dermoscopic characteristics of 55 atypical Spitz tumors and 110 Spitz nevi that were excised and diagnosed histopathologically. Clinical and dermoscopic images of atypical Spitz tumors were collected from the databases of 7 pigmented lesions clinics in Italy (Reggio Emilia, Naples, Modena, Turin, Milan) and Spain (Barcelona, Tarragona). The inclusion criterion was the availability of a clinical and dermoscopic image of a

Results

In all, 165 patients (65 male and 100 female) were included. Mean age was 28.4 ± 13.5 years for female and 26.4 ± 31.9 years for male patients. Mean age was 20.8 ± 13.8 years in the atypical Spitz tumors group, and 31.0 ± 12.3 years in the Spitz nevi group (Student t test, P < .0001).

Frequencies of the observed clinical and dermoscopic variables are reported in Tables II and III .

The majority of atypical Spitz tumors presented as nodular lesions (32/55, 58.2%), whereas Spitz nevi were more

Discussion

Our study provides novel insights into the clinical and dermoscopic morphology of atypical Spitz tumors, as compared with Spitz nevi. According to our findings, atypical Spitz tumors develop either as pigmented nodular lesions with a multicomponent or unspecific pattern dermoscopically, or as nonpigmented nodular lesions with a typical Spitzoid pattern on dermoscopy. In contrast, detection of a pigmented typical Spitzoid pattern (the so-called starburst pattern) is highly suggestive of Spitz

References (28)

  • J.M. Mones et al.

    “Atypical” Spitz's nevus, “malignant” Spitz's nevus, and “metastasizing” Spitz's nevus: a critique in historical perspective of three concepts flawed fatally

    Am J Dermatopathol

    (2004)
  • T. Wiesner et al.

    Kinase fusions are frequent in Spitz tumors and Spitzoid melanomas

    Nat Commun

    (2014)
  • G. Ferrara et al.

    Pediatric atypical Spitzoid neoplasms. A review with emphasis on ‘red’ (‘Spitz’) tumors and ‘blue’ (‘Blitz’) tumors

    Dermatology

    (2010)
  • M.W. Ludgate et al.

    The atypical Spitz tumor of uncertain biologic potential: a series of 67 patients from a single institution

    Cancer

    (2009)
  • Cited by (43)

    • Melanocytic nevus

      2023, FMC Formacion Medica Continuada en Atencion Primaria
    • The diagnostic value and histologic correlate of distinct patterns of shiny white streaks for the diagnosis of melanoma: A retrospective, case-control study

      2018, Journal of the American Academy of Dermatology
      Citation Excerpt :

      Likewise, a relatively symmetric lesion suspected to be a Spitz nevus or nevus of Reed in younger patients with SWSs may still be a candidate for clinical monitoring depending on other clinical parameters (Fig 4). The presence of SWSs organized as orthogonal lines is 1 pattern of SWSs that can be seen in spitzoid neoplasms.14,21,22 All our melanoma cases with SWSs had 2 or more additional melanoma-specific dermoscopic features.

    • Clinical and dermoscopic characterization of pediatric and adolescent melanomas: Multicenter study of 52 cases

      2018, Journal of the American Academy of Dermatology
      Citation Excerpt :

      Dermoscopic specific features were scored as present or absent. For the global dermoscopic pattern classification, we integrated criteria from pattern analysis,12 from a study on nevus-associated melanomas13 and from a study of atypical spitzoid tumors.14 This culminated in use of the following descriptive patterns: (1) multicomponent pattern (>2 dermoscopic structures [reticular, globular, or homogeneous]), asymmetrically distributed; (2) nevus-like pattern (≤2 dermoscopic structures [reticular, globular, or homogeneous]), symmetrically distributed; (3) pink spitzoid pattern (hypomelanotic or amelanotic tumors with a diffuse vascular pattern); (4) pigmented Reed-like pattern (starburst pattern of streaks or large globules at the periphery); and (5) nonclassifiable nodules (exophytic tumors not attributable to any of the aforementioned categories).

    View all citing articles on Scopus

    Supported in part by the Italian Ministry of Health (RF-2010-2316524). Research at the Melanoma Unit in Hospital Clinic Barcelona is partially funded by grants 03/0019, 05/0302, 06/0265, 09/1393, and 12/00840 from Fondo de Investigaciones Sanitarias, Spain; by the CIBER de Enfermedades Raras of the Instituto de Salud Carlos III (Fondo Investigaciones Sanitarias FIS numbers 09/01393 and 12/00840), Spain; by the Agencia de Gestio d'Ajuts Universitaris i Recerca numbers AGAUR 2009 SGR 1337 and AGAUR 2014_SGR_603 of the Catalan Government, Spain; by the European Commission under the 6th Framework Programme, Contract No: LSHC-CT-2006-018702 (through GenoMEL); and by the National Cancer Institute of the US National Institutes of Health (CA83115). The sponsors had no role in the design and conduct of the study; in the collection, analysis and interpretation of data; or in the preparation, review, or approval of the manuscript.

    Conflicts of interest: None declared.

    View full text