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Multicenter Study
. 2015 Nov;73(5):777-84.
doi: 10.1016/j.jaad.2015.08.018.

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

Elvira Moscarella  1 , Aimilios Lallas  1 , Athanassios Kyrgidis  1 , Gerardo Ferrara  2 , Caterina Longo  1 , Massimiliano Scalvenzi  3 , Stefania Staibano  4 , Cristina Carrera  5 , M Alba Díaz  5 , Paolo Broganelli  6 , Carlo Tomasini  6 , Stefano Cavicchini  7 , Raffaele Gianotti  8 , Susana Puig  9 , Josep Malvehy  9 , Pedro Zaballos  10 , Giovanni Pellacani  11 , Giuseppe Argenziano  12
Affiliations
Multicenter Study

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

Elvira Moscarella et al. J Am Acad Dermatol. 2015 Nov.

Abstract

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.

Keywords: Spitz nevus; atypical Spitz tumor; dermoscopy; histopathology; melanoma; skin cancer.

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Figures

Figure 1
Figure 1
Clinical and dermoscopic features of amelanotic AST (atypical Spitz tumor). A. Clinical image of an amelanotic nodular lesion, arising on the abdomen of a 25 year-old woman. B. On dermoscopy, dotted vessels and white lines are visible over a pinkish background. C. Clinical image of an amelanotic nodule arising on the extremity of a 19 year-old boy. B. On dermoscopy, the lesion shows a nonspecific pattern, with polymorphic vessels, ulceration and white lines.
Figure 2
Figure 2
Clinical and dermoscopic features of hypomelanotic AST (atypical Spitz tumor). A. Clinical appearance of a hypomelanotic nodule arising on the lower limb of a 34 year-old woman. B. On dermoscopy the lesion exhibits a multicomponent pattern, with homogeneous brown pigmentation, white lines and polymorphic vessels. C. Clinical appearance of a hypopigmented nodule arising on the leg of a 22 year-old boy. D. On dermoscopy, nonspecific pattern is detected, with polymorphic vessels, brownish pigmentation, and ulceration.
Figure 3
Figure 3
Clinical and dermoscopic features of pigmented AST (atypical Spitz tumor).A. Clinical image of a nodule arising on the forearm of a 3 year-old girl. B. On dermoscopy, a multicomponent pattern is detected, with irregular globules, and irregular homogeneous brown and pink pigmentation. C. Clinical appearance of a pigmented nodule arising on the lower limb of a 15 year-old girl. D. On dermoscopy, a multicomponent pattern is visible, with irregular streaks, homogeneous brown pigmentation, blue-white veil and crystalline structures.
See this image and copyright information in PMC

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