Casso E M, Grin-Jorgensen C M, Grant-Kels J M
Division of Dermatology, University of Connecticut, Farmington 06030.
J Am Acad Dermatol. 1992 Dec;27(6 Pt 1):901-13. doi: 10.1016/0190-9622(92)70286-o.
The Spitz nevus has long been defined as a benign melanocytic lesion that shares many histologic features with malignant melanoma. Despite the diagnostic criteria established for these two entities, their histologic similarities continue to make their distinction somewhat difficult. Uncertainties also exist with regard to the natural history of the Spitz nevus; the true pattern of this lesion's biologic behavior remains elusive. As a result, controversies exist with respect to appropriate therapy. To examine these controversies, the epidemiology, clinical features, and histopathology of Spitz nevi, as well as the role of recent molecular and immunohistochemical diagnostic studies, are discussed. However, the primary focus of this article is the natural course, prognosis, and treatment of the Spitz nevus. A review of 716 cases of Spitz nevi, compiled from 13 papers published from 1948 to 1990, is presented. After analyzing this and other available data, we propose that at this time Spitz nevi and malignant melanoma cannot easily be categorized as distinct entities and that perhaps they actually exist along one continuum of disease. Because of this uncertainty and the difficulties in differentiating these two lesions, we recommend that treatment include complete excision of all Spitz nevi followed by reexcision of positive margins if present.
斯皮茨痣长期以来被定义为一种良性黑素细胞病变，它与恶性黑色素瘤有许多组织学特征相同。尽管已经为这两种病变制定了诊断标准，但它们在组织学上的相似性仍然使区分它们有些困难。关于斯皮茨痣的自然病史也存在不确定性；这种病变生物学行为的真实模式仍然难以捉摸。因此，在适当治疗方面存在争议。为了探讨这些争议，本文讨论了斯皮茨痣的流行病学、临床特征和组织病理学，以及近期分子和免疫组化诊断研究的作用。然而，本文的主要重点是斯皮茨痣的自然病程、预后和治疗。本文呈现了对1948年至1990年发表的13篇论文中汇编的716例斯皮茨痣病例的综述。在分析这些数据和其他可用数据后，我们提出，目前斯皮茨痣和恶性黑色素瘤不能轻易被归类为不同的实体，也许它们实际上存在于疾病的一个连续统一体中。由于这种不确定性以及区分这两种病变的困难，我们建议治疗方法包括完整切除所有斯皮茨痣，如果切缘阳性则再次切除。
