The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York 10016, USA.
JAMA Dermatol. 2013 Mar;149(3):283-91. doi: 10.1001/jamadermatol.2013.1124.
Controversy exists regarding strategies for diagnosis and management of Spitz nevi, a type of melanocytic neoplasm that most often develops in children.
To determine the beliefs, behaviors, and experiences of pediatric dermatologists with regard to Spitz nevi.
Anonymous web-based survey.
Private and academic dermatology practices.
Respondents included 175 pediatric dermatologists from the United States and around the world, representing a 51.1% response rate (175 of 342). Analyses were limited to the 144 respondents whose practices included at least 50% children (younger than 18 years).
Assessment of the following with regard to Spitz nevi: frequency of diagnosis, general beliefs, techniques used for evaluation (eg, dermoscopy and biopsy), management strategies, and observed outcomes.
Collectively, respondents had seen approximately 20 000 Spitz nevi; 67.6% (96 of 142) had diagnosed at least 6 Spitz nevi yearly, whereas 90.1% (128 of 142) had diagnosed no more than 2 prepubertal melanomas in the past 5 years. Ninety-six percent of respondents (95.8%; 136 of 142) categorized typical Spitz nevi as benign. Eighty percent of respondents (79.6%; 113 of 142) used dermatoscopy, and 96.5% (137 of 142) avoided partial biopsies of Spitz nevi. In children with a suspected Spitz nevus, clinical follow-up was chosen by 49.3% (69 of 140) of respondents for a small, stable nonpigmented lesion and by 29.7% (41 of 138) for a pigmented lesion with a typical starburst pattern seen via dermatoscopy. Predictors of clinical follow-up of the latter lesion included believing that Spitz nevi are not melanoma precursors (P = .04). Forty-seven percent (62 of 132) of respondents had observed involution of Spitz nevi. No deaths had resulted from the approximately 10 000 Spitz nevi or atypical spitzoid neoplasms seen by the 91 respondents with academic or hospital-based practices.
The results of our survey support conservative management of Spitz nevi in children, with clinical follow-up representing an option for typical lesions. This represents an important difference from strategies used for management of these lesions in adults.
Spitz 痣是一种黑色素瘤肿瘤，主要发生在儿童，目前对于其诊断和治疗策略存在争议。
确定儿科皮肤科医生对 Spitz 痣的看法、行为和经验。
匿名网络调查。
私人和学术皮肤科诊所。
来自美国和世界各地的 175 名儿科皮肤科医生参加了这项研究，应答率为 51.1%（342 人中的 175 人）。分析仅限于其从业实践中至少有 50%的患者为儿童（18 岁以下）的 144 名应答者。
评估 Spitz 痣的以下情况：诊断频率、一般观念、评估技术（如皮肤镜检查和活检）、管理策略和观察结果。
总体而言，应答者共观察了约 20000 例 Spitz 痣；67.6%（142 人中的 96 人）每年至少诊断 6 例 Spitz 痣，而 90.1%（142 人中的 128 人）在过去 5 年中诊断的青春期前黑色素瘤不超过 2 例。96%的应答者（95.8%；142 人中的 136 人）将典型 Spitz 痣归类为良性。80%的应答者（142 人中的 113 人）使用皮肤镜检查，96.5%（142 人中的 137 人）避免对 Spitz 痣进行部分活检。对于疑似 Spitz 痣的儿童，49.3%（140 人中的 69 人）的应答者选择临床随访治疗小而稳定的非色素性病变，29.7%（138 人中的 41 人）选择有典型星爆模式的色素性病变进行皮肤镜检查。对于后者，选择临床随访的预测因素包括认为 Spitz 痣不是黑色素瘤前体（P=0.04）。47%（132 人中的 62 人）的应答者观察到 Spitz 痣的消退。在 91 名有学术或医院实践的应答者中，大约 10000 例 Spitz 痣或非典型 Spitz 样肿瘤没有导致死亡。
我们的调查结果支持对儿童 Spitz 痣进行保守治疗，对典型病变进行临床随访是一种选择。这与成人治疗这些病变的策略有重要区别。
