Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec 18;8(12):e3244.
doi: 10.1097/GOX.0000000000003244. eCollection 2020 Dec.

Management of Residual Spitz Nevus in Surgical Specimens following Biopsy and Excision

Usha E A Beijnen  1 , Landis R Walsh  1 , Laura C Nuzzi  1 , Birgitta A R Schmidt  2 , Brian I Labow  1 , Amir H Taghinia  1
Affiliations

Management of Residual Spitz Nevus in Surgical Specimens following Biopsy and Excision

Usha E A Beijnen et al. Plast Reconstr Surg Glob Open. .

Abstract

Proper management of Spitz nevi continues to be debated, with treatment ranging from observation to surgery. To better characterize the outcome of surgical procedures performed for incomplete initial excision or biopsy, we sought to ascertain the histopathological presence of residual Spitz nevi in a set of surgical specimens.

Methods: We retrospectively reviewed 123 records with histologically-confirmed Spitz nevus. Data concerning treatment, clinical features, histopathological margin involvement, and presence of residual lesion on subsequent procedural specimens were collected.

Results: Fifty-three percent of lesions (n = 65) were initially sampled by shave or punch biopsy, and the remainder (n = 58) were formally excised without initial biopsy. The rates of re-excision for involved margins were: shave biopsy (92.2%), punch biopsy (78.6%), and formal excision (13.8%). In total, 61.0% of patients who underwent an initial procedure of any kind had involved margins, but only half of those re-excised for involved margins (57.6%) had histologically residual lesion on repeated excision. A significantly higher proportion of initial punch biopsies (90.9%) resulted in residual lesion (in secondary excision specimens) when compared with shave biopsy (48.9%) and formal excision (62.5%; P < 0.05).

Conclusions: Findings suggest that clinicians may consider shave biopsy over punch biopsy for diagnosing suspected lesions, when indicated and appropriate. Given the rarity of malignant transformation and the frequency of residual nevus, observation may be reasonable for managing pediatric patients with histologically-confirmed Spitz nevi, who are post initial biopsy or excision despite known histopathological margin involvement.

PubMed Disclaimer

Conflict of interest statement

Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Figures

Fig. 1.
Fig. 1.
The clinical course of a typical patient who presented with a suspected Spitz nevus. If margins were involved (“Positive margin”), most (but not all) underwent a secondary excision procedure. The outcome of interest was the presence of histopathologically-confirmed residual lesion on this secondary specimen.
Fig. 2.
Fig. 2.
Summary flow diagram of patient outcomes.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Spitz S. Melanomas of childhood. Am J Pathol. 1948;24:591–12. - PMC - PubMed
    1. Crotty KA, Scolyer RA, Li L, et al. Spitz naevus versus spitzoid melanoma: when and how can they be distinguished? Pathology. 2002;34:6–12. - PubMed
    1. Dika E, Ravaioli GM, Fanti PA, et al. Spitz nevi and other spitzoid neoplasms in children: Overview of incidence data and diagnostic criteria. Pediatr Dermatol. 2017;34:25–32. - PubMed
    1. Peris K, Ferrari A, Argenziano G, et al. Dermoscopic classification of Spitz/Reed nevi. Clin Dermatol. 2002;20:259–262. - PubMed
    1. Abboud J, Stein M, Ramien M, et al. The diagnosis and management of the Spitz nevus in the pediatric population: A systematic review and meta-analysis protocol. Syst Rev. 2017;6:81. - PMC - PubMed