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Research Letter |

Differences in Treatment of Spitz Nevi and Atypical Spitz Tumors in Pediatric Patients Among Dermatologists and Plastic Surgeons

Amy T. Metzger, MD1; Alex A. Kane, MD2; Susan J. Bayliss, MD3
[+] Author Affiliations
1Department of Dermatology, Tulane University, New Orleans, Louisiana
2Department of Plastic Surgery, University of Texas Southwestern, Dallas
3Division of Dermatology, Washington University, St Louis, Missouri
JAMA Dermatol. 2013;149(11):1348-1350. doi:10.1001/jamadermatol.2013.4947.
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No clear consensus exists for the management of Spitz nevi (SNs) or atypical Spitz tumors (ASTs), particularly in the pediatric population. Some dermatologists recommend the removal of all suspected Spitz tumors in children, whereas others perform partial biopsy or monitor clinically.1

Article InformationCorresponding Author: Amy T. Metzger, MD, Department of Dermatology, Tulane University, 1430 Tulane Ave, Ste 8036, New Orleans, LA 70112 (ametzger@tulane.edu).

Accepted for Publication: April 4, 2013.

Published Online: September 11, 2013. doi:10.1001/jamadermatol.2013.4947.

Author Contributions: All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition of data: Metzger.

Analysis and interpretation of data: Metzger, Kane.

Drafting of the manuscript: Metzger, Kane.

Critical revision of the manuscript for important intellectual content: Kane, Bayliss.

Administrative, technical, or material support: Kane.

Study supervision: Kane, Bayliss.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the plastic surgeons and dermatologists who took time out of their busy schedules to complete the survey.

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Figure 1.
Management of Clinically Suspected Spitz Nevi

Spitz nevi in a 7-year-old patient (A) and in an 18-year-old patient (B). “Other” includes physicians who would base management on clinical factors, such as site and size or the lesion and family and patient anxiety about the lesion.aP ≤ .05.

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Figure 2.
Further Treatment of Clinical Recurrence of Spitz Nevi

A, Spitz nevus with typical histologic characteristics. B, Spitz nevus with typical histologic characteristics and a positive margin. C, Atypical Spitz tumor with negative margins. D, An atypical Spitz tumor with a positive margin. LND indicates lymph node dissection; SLNB, sentinel lymph node biopsy.aP ≤ .05.

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