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A Clinicopathologic Study of 83 Cases

Gerardo Ferrara, MD; Giuseppe Argenziano, MD; H. Peter Soyer, MD; Sergio Chimenti, MD; Arturo Di Blasi, MD; Giovanni Pellacani, MD; Ketty Peris, MD; Domenico Piccolo, MD; Pietro Rubegni, MD; Stefania Seidenari, MD; Stefania Staibano, MD; Iris Zalaudek, MD; Gaetano De Rosa, MD

Arch Dermatol. 2005;141:1381-1387.

Objective  To achieve a clinicopathologic classification of Spitz nevi by comparing their clinical, dermoscopic, and histopathologic features.

Design  Eighty-three cases were independently reviewed by 3 histopathologists and preliminarily classified into classic or desmoplastic Spitz nevus (CDSN, n = 11), pigmented Spitz nevus (PSN, n = 14), Reed nevus (RN, n = 16), or atypical Spitz nevus (ASN, n = 14); the remaining 28 cases were then placed into an intermediate category (pigmented Spitz-Reed nevus, PSRN) because a unanimous diagnosis of either PSN or RN was not reached.

Setting  University dermatology and pathology departments and general hospital pathology departments.

Patients  A sample of subjects with excised melanocytic lesions.

Main Outcome Measure  Frequency of dermoscopic patterns within the different histopathologic subtypes of Spitz nevi.

Results  Overlapping clinical, dermoscopic, and histopathologic findings were observed among PSN, RN, and PSRN, thereby justifying their inclusion into the single PSRN diagnostic category. Asymmetry was the most frequent indicator of histopathologic ASN (79%; n = 11); in only 4 cases did dermoscopic asymmetry show no histopathologic counterpart, and in those cases the discrepancy was probably the result of an artifact of the gross sampling technique carried out with no attention to the dermoscopic features.

Conclusions  Among Spitz nevi, histopathologic distinction between PSN and RN is difficult, not reproducible, and may be clinically useless. A simple clinicopathologic classification of these neoplasms might therefore be structured as CDSN, PSRN, and ASN. Asymmetry should be assessed using both dermoscopic and histopathologic analysis, and reliability in histopathologic diagnosis may be enhanced by the simultaneous evaluation of the corresponding dermoscopic images.

Author Affiliations: Pathologic Anatomy Service, Gaetano Rummo General Hospital, Benevento (Drs Ferrara and Di Blasi); Departments of Dermatology, Second University of Naples, Naples (Dr Argenziano), University of Tor Vergata, Rome (Dr Chimenti), University of Modena, Modena (Drs Pellacani and Seidenari), University of L’Aquila, L’Aquila (Drs Peris and Piccolo), and University of Siena, Siena (Dr Rubegni), Italy; Department of Dermatology, Medical University of Graz, Graz, Austria (Drs Soyer and Zalaudek); and the Pathology Institute of the Federico II University of Naples, Naples (Drs Staibano and De Rosa).

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