Screening Children Part 2 - Spitzoid Nevi

Question 1

Dermatopathology spitz nevus

Answer 1

Proliferation of large spindle and epithelioid cells
Junctional, dermal, or compound
Associated with conspicuous epidermal hyperkeratosis or acanthosis
Little or no pigment deposition

Question 2

Dermatopathology Reed Nevus

Answer 2

Pigmented spindle cell nevus
Heavily pigmented
Monomorphic
Small to medium spindle melanocytes
Bandlike dermal infiltration of melanophages

Question 3

Do we distinguish between pigmented spitz and reed nevi

Answer 3

NO because they are same from clinical point of view

Question 4

How do non pigmented spitz nevi present

Pigmented lesion

Answer 4

Reddish papules or nodules

Very visible brown to black pigmentation

Question 5

Spitz nevi, preferential sites

Answer 5

Face
Acral sites
Buttocks

Question 6

Spitz nevi, dermoscopic patterns

Answer 6

Reticular pigmentation with dotted vessels
Dotted vessels in pink background in non pigmented lesion
Pigmented lesion usually present with starburst pattern - peripheral symmetrical streaks around lesion
Or globular pattern with big brown to black globules
Or the so called superficial black network in heavily pigmented lesions area of hyperkeratosis with superficial black network visible on surface of lesion
Atypical or multi-component pattern which resembles a melanoma.

Question 7

Spitz nevus Ddx

Answer 7

Viral warts - splinter hemorrhages
Xanthogranulma - yellowish appearance clinically and dermoscopically
Pilomatrixoma - nodular, firm, bluish component
Pyogenic granuloma - impossible to distinguish from spitz nevus

Question 8

Evolution spitz nevi

Answer 8

Starburst
Globular
Starburst

Question 9

Management Spitz nevi

Answer 9

Children < 12:Dermoscopy follow up every 6-12 months for 2-3 years and then once a year until stabilization or involution.
In children 12 and older follow every year for lesions with typical clinical and dermoscopic features and surgical removal of all Spitz nevi with atypical features

Question 10

Spitz nevi excluded for conservative follow up

Answer 10

Nodular lesions
Atypical lesions
Multi-component pattern

Question 11

Follow up is becoming standard of care in …..

Answer 11

Flat symmetrical spitzoid lesions in patients < 12 years

Question 12

What is atypical spitz tumour

Answer 12

Histopathological features not sufficient for diagnosis of melanoma, capable of nodal metastases, with no further spread

Question 13

Incidence AST

Answer 13

6-8% of Spitz nevi

Question 14

Clinical presentation AST

Answer 14

First 2 decades life
Medium to large <7 mm
Nodular
Rarely ulcerated
Mostly hypopigmented or amelanotic cutaneous lesion

Question 15

AST controversies

Answer 15

1. AST are biologically benign nevi that have features in common with melanoma
2. AST are biological intermediates between nevi and conventional melanoma
3. AST represent a subset of melanomas with a better prognosis than conventional melanoma.

Question 16

Clinical features that increase the risk of AST

Answer 16

Nodular
Non pigmented
Ulcerated

Question 17

Does typical non pigmented spitzoid pattern r/o AST

Answer 17

No

Question 18

Pink nodule with dotted vessels or atypical vessels with milky red colour has the following Ddx

Answer 18

Spitz nevus
AST
Melanoma

Question 19

Management AST

Answer 19

Review histopathological

Wide excision

Question 20

FISH probes are used to

Answer 20

Categorize risk of metastases

Question 21

AST and sentinel lymph node diagnostic

Answer 21

No prognostic value

Not performed

Question 22

What % AST have positive sentinel node bx

Answer 22

39%

Question 23

AST prognosis

Answer 23

99% survival at 5 years.