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


Topic Completed: 1 February 2013

Minor changes: 3 November 2020

Copyright: 2002-2021, PathologyOutlines.com, Inc.

PubMed Search: Spitz nevus

See also: Atypical Spitz nevus, Desmoplastic Spitz nevus

Christopher S. Hale, M.D.
Page views in 2020: 17,308
Page views in 2021 to date: 9,352
Cite this page: Hale CS. Spitz nevus. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skintumormelanocyticspitz.html. Accessed June 16th, 2021.
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

AFIP 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

Scroll to see all images:

AFIP images

Bilaterally
symmetric lesion
has uniform
hyperkeratosis

Various images

Melanocytes
extend focally
into epidermis,
mostly as nests

Pink eosinophilic
globoid; Kamino
bodies are probably
apoptotic cells

Various images



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

Junctional

Intradermal


Compound

Trunk

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)
Back to top
Image 01 Image 02