Paediatric spitzoid proliferations. (1st August 2019) - Bartenstein, D.W.
Summary: Spitz naevi are a type of mole (brown skin lump). They are smooth, rounded, pink, red or brown. They contain pigment cells known as spitzoid proliferations. Some spitz naevi look quite worrying, growing rapidly and dark brown in colour, and yet turn out to be benign (harmless) when looked at under the microscope, while others contain atypical (abnormal) or even malignant cells. Even viewing them under a powerful magnifying glass (dermatoscope) does not show whether they are malignant (cancerous); genetic tests provide clues but are not easily available. Consequently it is hard to advise patients, especially children because most of the published data is from adults. So these American doctors reviewed 622 spitzoid proliferations removed at Boston Children's Hospital between 1994 and 2012. Most (82.3%) were benign, 17.2% contained cells that looked worrying (atypical) and 3 (0.5%) turned out to be malignant melanomas. On further investigation they found that patients with malignant lesions were, on average, older (17.2 years) than those with atypical or benign lesions (7.2 and 7.4 years respectively), but tumour type was not linked with skin colour or gender. The 3 melanomas occurred in white people, one on the arm, and the other two on or around the buttocks. Two of the 3 had other tumours but all 3 were alive with no recurrences of skin tumour when last reviewed 4‐17 years after diagnosis. Five typical spitz naevi came back as atypical naevi after being partially removed. The authors conclude that it may not be necessary to remove benign‐looking spitz naevi in children.