Skin - Melanocytic tumor
Nevi
Spitz nevus

Author: Christopher Hale, M.D. (see Authors page)

Revised: 27 February 2017, last major update February 2013

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Spitz nevus

See also: Atypical Spitz nevus, Desmoplastic Spitz nevus
Cite this page: Spitz nevus. PathologyOutlines.com website. http://pathologyoutlines.com/topic/skintumormelanocyticspitz.html. Accessed September 24th, 2017.
Definition / general
Terminology
  • Also called spindle and epithelioid cell nevus, benign juvenile melanoma
  • First described by Sophie Spitz in 1948 (Am J Surg Pathol 1948;24:591)
Epidemiology
Sites
Clinical features
  • Small, raised, pink / red or brown / black nodule
  • May resemble hemangioma or pyogenic granuloma
  • Usually 6 mm or smaller
  • Usually single but may be multiple and clustered (agminate) or multiple and disseminated
  • Benign but may recur if incompletely excised (Am J Surg Pathol 2002;26:654)
  • May involve regional lymph nodes, particularly atypical lesions (Am J Surg Pathol 2002;26:47)
  • Common cause of malpractice claims is misdiagnosis as melanoma (Arch Pathol Lab Med 2006;130:617)
Case reports
Treatment
  • Complete excision with evaluation of margins
  • Clinical followup, particularly of multiple or atypical lesions
Clinical images

Images hosted on PathOut server:

Small, symmetrical pinkish tan lesion



Images hosted on other servers:

Various images

On ear of child

11 year old boy with dark pigmented arm lesion

Microscopic (histologic) description
  • Symmetric with sharp lateral borders, usually compound nevus with prominent intraepidermal component
  • 5% are junctional, 20% are dermal
  • Composed of spindled and epithelioid cells
  • Spindle cells may be arranged in fascicles in dermal papillae, are perpendicular to epidermis, cigar shaped with large nuclei, have prominent nucleoli
  • Epithelioid cells are dispersed individually, polygonal with abundant eosinophilic cytoplasm, distinct cell borders, large nuclei and prominent nucleoli, have variable mitotic figures, occasional multinucleation and often marked atypia, although most cells appear benign
  • Cell maturation occurs in deep portion of tumor
  • Also large and well formed Kamino bodies (eosinophilic hyaline bodies along dermoepidermal junction)
  • May have pagetoid growth, lymphatic invasion, pseudoepitheliomatous hyperplasia, "tubular" growth pattern, plexiform growth pattern, halo reaction, prominent vasculature (Am J Dermatopathol 2000;22:135) and lymphocytic infiltrate
  • Scanty pigmentation
  • "Consumption of epidermis" (usually associated with melanoma) is seen in 10%, defined as thinning of epidermis with attenuation of basal and suprabasal layers and loss of rete ridges in areas of direct contact with neoplastic melanocytes (Am J Surg Pathol 2004;28:1621)
Microscopic (histologic) images

Scroll to see all images.


Images hosted on PathOut server:

AFIP images:

Bilaterally symmetric lesion has uniform hyperkeratosis with hypergranulosis,
fairly uniformly elongated rete ridgesand a proliferation of melanocytes
in the epidermis that "rain down" through the papillary dermis
into the reticular dermis as attenuated spindle cells

Fig A: bilaterally symmetrical lesion
Fig B: has lateral cells arranged in nests
Fig C: indicating that the lesion is well circumscribed; "transepidermal elimination" does not indicate pagetoid spread
Fig D: dermal lesional cells show imperfect but definite maturation with attenuated single cells at the base of the lesion


Melanocytes extend focally into epidermis, mostly as nests;
the maturation into the dermis, globoid bodies in epidermis
and characteristic cell type are attributes of Spitz nevus, not melanoma


Pink eosinophilic globoid
Kamino bodies are probably
apoptotic cells

Fig A: giant cells are commonly seen in Spitz nevi
Fig B: as are the large intranuclear cytoplasmic
invaginationsthat may also be seen in melanomas


Fig A: mitotic figures, if not numerous and especially when entirely superficial, are not indicative of melanoma
Fig B: maturation from large epithelioid cells to small nevus cells, from superficial to deep, within a Spitz nevus is an
extremely important diagnostic feature, as is the permeation of reticular dermis by attenuated single cells at the base



Contributed by Angel Fernandez-Flores, M.D., Ph.D., Hospital El Bierzo and Clinica Ponferrada, Spain:

Various images



Images hosted on other servers:

Various images

Compound Spitz nevus


Lip lesion

Cells demonstrate pleomorphism

Symmetric circumscribed lesion

Nests of tumor cells with Kamino bodies

Nests of spindle cells


Nests of epithelioid cells

Multinucleated cells

Junctional

Intradermal


Compound

Trunk

Limited Ki67 staining


Strong S100A6 staining

Various images

Spitz nevus: figures a - c

Compound Spitz tumor



Comparison with melanoma:

Fig A - H: Spitz nevus
Fig I: compared to spitzoid melanoma

Positive stains
Negative stains
Molecular / cytogenetics description
Differential diagnosis
  • Atypical Spitz nevus
  • Spitzoid melanoma: asymmetric, irregular lateral borders, uneven base, pagetoid scatter of melanocytes, uneven nests of melanocytes, lack of maturation, spindle cells not perpendicular to surface, epidermal spread, ulcerated surface, most cells appear malignant (Clin Dermatol 2009;27:545)