The surgical management of Spitz nevi.
BACKGROUND
The biologic behavior of Spitz nevi and atypical Spitz nevi ranges from completely benign to the rare malignant melanoma. Various recommendations for the surgical approach to these lesions have been proposed.


OBJECTIVE
To determine any trend in the surgical management of Spitz nevi and atypical Spitz nevi among a community of dermatologists.


METHODS
Retrospective review of the clinical features, surgical management and outcome of 89 patients with the diagnosis of Spitz nevus or atypical Spitz nevus.


RESULTS
All biopsy techniques had a high incidence of involved margins: shave (67%), excision (28%), and punch (21%). Of the atypical Spitz nevi with positive margins on biopsy, there was a trend (7/9) toward reexcision with narrow margins (average 2.2 mm).


CONCLUSIONS
The majority of atypical Spitz nevi incompletely removed by biopsy were excised with narrow uncontrolled margins. A stratified surgical approach depending on the clinical and histopathologic features of the Spitz lesion is proposed. More aggressive surgical management of Spitz lesions with atypical features may be warranted. Further studies to determine the biologic potential of these lesions are needed.
Murphy
Michael E
ME
Department of Dermatology, Walter Reed Army Medical Center, Washington, DC 20307, USA. murphymd@aol.com
Boyer
John D
JD
Stashower
Mitchell E
ME
Zitelli
John A
JA
D000328:Adult; D001706:Biopsy / Q000379:methods; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D018332:Nevus, Epithelioid and Spindle Cell / Q000175:diagnosis / Q000601:surgery*; D012307:Risk Factors; D012867:Skin / Q000473:pathology*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome