Murphy Michael E, Boyer John D, Stashower Mitchell E, Zitelli John A
Department of Dermatology, Walter Reed Army Medical Center, Washington, DC 20307, USA.
Dermatol Surg. 2002 Nov;28(11):1065-9; discussion 1069. doi: 10.1046/j.1524-4725.2002.02067.x.
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.
To determine any trend in the surgical management of Spitz nevi and atypical Spitz nevi among a community of dermatologists.
Retrospective review of the clinical features, surgical management and outcome of 89 patients with the diagnosis of Spitz nevus or atypical Spitz nevus.
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).
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.
斯皮茨痣和非典型斯皮茨痣的生物学行为范围从完全良性到罕见的恶性黑色素瘤。针对这些病变的手术方法已提出了各种建议。
确定皮肤科医生群体中对斯皮茨痣和非典型斯皮茨痣的手术治疗趋势。
回顾性分析89例诊断为斯皮茨痣或非典型斯皮茨痣患者的临床特征、手术治疗及结果。
所有活检技术切缘受累的发生率都很高：刮除术（67%）、切除术（28%）和钻孔术（21%）。活检切缘阳性的非典型斯皮茨痣有再次切除切缘较窄（平均2.2毫米）的趋势（7/9）。
活检未完全切除的大多数非典型斯皮茨痣切除时切缘控制不佳且较窄。建议根据斯皮茨病变的临床和组织病理学特征采取分层手术方法。对于具有非典型特征的斯皮茨病变，可能需要更积极的手术治疗。需要进一步研究以确定这些病变的生物学潜能。
