Skin melanocytic tumor
Spitzoid neoplasms, BAP1 inactivated neoplasms, and deep penetrating nevi
Spitz nevus

Topic Completed: 1 February 2013

Minor changes: 2 April 2020

Copyright: 2002-2019,, Inc.

PubMed Search: Spitz nevus

See also: Atypical Spitz nevus, Desmoplastic Spitz nevus

Christopher S. Hale, M.D.
Page views in 2019: 16,861
Page views in 2020 to date: 10,266
Cite this page: Hale C. Spitz nevus. website. Accessed August 14th, 2020.
Definition / general
  • Also called spindle and epithelioid cell nevus, benign juvenile melanoma
  • First described by Sophie Spitz in 1948 (Am J Surg Pathol 1948;24:591)
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
  • Complete excision with evaluation of margins
  • Clinical followup, particularly of multiple or atypical lesions
Clinical images

Small, symmetrical pinkish tan lesion

Images hosted on other servers:

On ear of child

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

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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.

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





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)
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