Spitz Naevus: 7 Key Clinical Features And Treatment Options

A

Spitz naevus

is a benign skin tumour. However, it may resemble a

melanoma

clinically and microscopically, so Spitz naevi are often excised as a precaution.

What is a Spitz naevus?

A Spitz naevus (also called Spitz nevus) is a type of

melanocytic naevus

, that is, it is a mole composed of

melanocytes

— these are cells that normally produce pigment,

melanin

, and are responsible for skin colour. The melanocytes in Spitz naevus may be inactive. Thus the lesion may be pink rather than brown.

The genetic pattern of the DNA in Spitz naevus is characteristic with

kinase fusions

being prominent.

It is not known why Spitz naevi occur.

Who gets Spitz naevi?

Spitz naevi are seen most often in

children

; 70% of cases diagnosed during the first 20 years of life. They may also arise in adults. They are most frequently found in

fair-skinned individuals

(skin phototypes I and II) but can also affect those with dark skin.

Types of Spitz naevus

Spitz naevus is classified as:

• **Classic Spitz naevus**
• **Pigmented Spitz naevus**
• **Spindle cell tumour of Reed**

There are clinical features in common for all three types of Spitz naevus.

The

atypical Spitz naevus

or spitzoid naevus is so called because its features differ from those seen in the majority of Spitz naevi.

The rare entity,

agminated Spitz naevus

, presents as multiple Spitz naevi in a segmental presentation. It is an example of

cutaneous mosaicism

and is due to a genetic mutation.

Clinical features

A Spitz naevus is often suspected clinically by its characteristic

dome-shaped appearance

and

rapid growth

over a few weeks to months.

• Usually 2–6 mm in diameter, but atypical examples may be larger
• Solitary lesion
• Symmetrical dome shaped or smooth surface
• Light to dark pink, reddish-brown to black
• Sometimes scaly or crusted surface
• Rapid growth over weeks to months
• Legs and face most common sites

In older children and adults, the diagnosis of Spitz naevus is usually confirmed by an

excisional skin biopsy

.

Classic Spitz naevus

Classic Spitz naevi are often

dome-shaped

and

reddish-brown to pinkish

, but they may also be colourless. They typically appear on the face, neck, or legs, grow quickly, and may itch, bleed, or ooze.

Pigmented Spitz naevus

Pigmented Spitz naevi may be light to dark brown or black. They are frequently found on the extremities and can mimic acral lentiginous melanoma in rare cases.

Spindle cell tumour of Reed

This variant features fusiform cells and can co-exist with other forms. It presents with similar clinical features but distinct histology.

Atypical Spitz naevus

Atypical features include:

• Larger size (>1 cm)
• Irregular borders
• Variable colour
• Scaly or ulcerated surface
• Often on the back

Agminated Spitz naevus

Multiple lesions confined to a segmental area due to mosaicism.

Diagnosis

The pathology of Spitz naevus usually shows a

symmetrical compound naevus

composed of nests of characteristic

epithelioid cells

in classic and pigmented Spitz, and

fusiform cells

in spindle cell tumour of Reed. Both forms can co-exist.

**Dermoscopy** reveals patterns such as starburst (peripheral pseudopods) or globular (large globules).

**Differential diagnosis** includes melanoma, especially atypical cases. Biopsy is essential in adults.

What is the treatment for Spitz naevus?

In children, small classic Spitz naevi may be left alone if the clinical diagnosis is certain. However, excision is often recommended due to diagnostic uncertainty.

In adults, excisional biopsy is standard to rule out melanoma.

Atypical Spitz tumours may require wider excision and sentinel lymph node biopsy in select cases.

Complications

Spitz naevi are benign but can cause anxiety due to melanoma mimicry. Rare malignant transformation reported in atypical variants.

Prevention

No known prevention. Regular skin checks recommended, especially in fair-skinned individuals.

Spitz Naevus vs Melanoma: Key Differences

Feature	Spitz Naevus	Melanoma
Age	Mostly <20 years	Any age, peaks later
Growth	Rapid then stable	Progressive
Symmetry	Symmetrical	Asymmetrical
Histology	Characteristic cells, maturation	Atypical mitosis, invasion

Frequently asked questions

Is Spitz naevus cancerous?

No, Spitz naevus is benign, though it mimics melanoma and is often excised.

Does Spitz naevus itch or bleed?

Yes, it may itch, bleed, or ooze, especially during rapid growth phase.

Can Spitz naevus appear in adults?

Yes, though less common than in children. Biopsy recommended.

How is Spitz naevus diagnosed?

By clinical exam, dermoscopy, and excisional biopsy with histopathology.

Do Spitz naevi disappear?

Some may flatten or regress over years, but excision is common.

This article provides an in-depth exploration of Spitz naevus, expanding on clinical variants, diagnostic challenges, and management strategies. While primarily affecting children, awareness is crucial for all ages due to its melanoma-like appearance. Early recognition through ABCDE criteria (Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving) aids differentiation, though biopsy remains gold standard. Genetic insights into kinase fusions offer future diagnostic promise. Regular dermatological surveillance is advised for at-risk populations.