Dermoscopy of Spitz Nevi and Atypical Spitzoid Lesions

Overview / Definition Spitz nevi are benign melanocytic neoplasms often found in children and young adults, characterized by a distinct histopathological appearance. Atypical spitzoid lesions present a diagnostic challenge due to their overlapping features with both Spitz nevi and melanoma, necessitating careful evaluation and management. Epidemiology Spitz nevi are more prevalent in children and adolescents, with a peak incidence between ages 2-16. Although they can occur at any age, atypical spitzoid lesions are often seen in older patients, and their incidence has been rising, correlating with increased awareness and screening. Spitz nevi: More common in children and young adults. Atypical spitzoid lesions: Increasing incidence in adults. Pathophysiology / Mechanism Spitz nevi arise from the proliferation of melanocytes in the epidermis and dermis, often exhibiting a combination of junctional and dermal components. The exact etiology remains unclear, but factors such as genetic predisposition and UV exposure may play a role. Atypical spitzoid lesions may demonstrate more aggressive growth patterns and atypical features that blur the line between benign and malignant. Clinical Presentation Clinically, Spitz nevi typically present as pink to reddish-brown papules or nodules, often with a smooth surface. They may be mistaken for other benign lesions, such as hemangiomas or seborrheic keratoses. Atypical spitzoid lesions may vary in color and have irregular borders, prompting further investigation. Spitz nevi: Asymptomatic, smooth papules, may have telangiectasia. Atypical spitzoid lesions: Irregular borders, variable pigmentation, may exhibit ulceration. Diagnosis / Workup Dermoscopy plays a pivotal role in the diagnosis of Spitz nevi and atypical spitzoid lesions. Key dermoscopic features include: Spitz nevi: Pink to reddish background Light brown or black starburst pattern Telangiectasias on the surface Atypical spitzoid lesions: Multiple colors (brown, black, pin