Costa Claudia, Megna Matteo, Cappello Milena, Napolitano Maddalena, Monfrecola Giuseppe, Scalvenzi Massimiliano
Department of Dermatology, University of Naples Federico II, Naples, Italy.
Department of Dermatology, University of Naples Federico II, Naples, Italy -
G Ital Dermatol Venereol. 2019 Feb;154(1):26-31. doi: 10.23736/S0392-0488.17.05523-7. Epub 2017 May 16.
Many efforts have been spent attempting to define clinical, histopathological and molecular markers for differential diagnosis of Spitz nevus and melanoma. Dermoscopy has been widely used but it may be not always sufficient.
A retrospective study was performed evaluating Spitzoid-looking lesions showing symmetry at clinical and dermoscopic examination in patients ≥12 years attending our Clinic from 2004 to 2014. Demographic, clinical and dermoscopic data were assessed for each lesion in order to highlight the most common characteristics which could help the differential diagnosis between Spitz nevus and melanoma when clinical or dermoscopic asymmetry is lacking.
A total of 760 lesions were excised. 690/760 (90.8%), were identified as typical Spitz nevi, whereas 70/760 lesions (9.2%) consisted of malignant melanocytic lesions. Our study showed that almost 9.2% of clinically and dermoscopically symmetric Spitzoid lesions revealed to be malignant melanocytic lesion. For symmetric Spitzoid looking lesions female sex, clinical palpability, the presence of an inverse network at dermoscopic examination and the involvement of lower limbs were observed as the main factors, which were linked to a higher possibility of being malignant lesions.
In order to avoid missing diagnoses for malignant melanocytic lesions, this study remarked the importance of preventive excision for all Spitzoid-looking lesions in patients ≥12 years, even if they show symmetry at both clinical and dermoscopic level.
人们已经付出诸多努力来定义用于鉴别Spitz痣和黑色素瘤的临床、组织病理学及分子标志物。皮肤镜检查已被广泛应用，但可能并不总是足够的。
进行了一项回顾性研究，评估2004年至2014年在我们诊所就诊的12岁及以上患者中临床和皮肤镜检查显示对称的Spitz样病变。对每个病变的人口统计学、临床和皮肤镜数据进行评估，以突出在缺乏临床或皮肤镜不对称性时有助于Spitz痣和黑色素瘤鉴别诊断的最常见特征。
共切除760个病变。其中690/760（90.8%）被确定为典型的Spitz痣，而70/760个病变（9.2%）为恶性黑素细胞病变。我们的研究表明，几乎9.2%临床和皮肤镜对称的Spitz样病变被发现是恶性黑素细胞病变。对于对称的Spitz样病变，女性、临床可触及性、皮肤镜检查时出现反向网络以及下肢受累被观察为主要因素，这些因素与病变为恶性的可能性较高有关。
为了避免漏诊恶性黑素细胞病变，本研究强调了对所有12岁及以上患者的Spitz样病变进行预防性切除的重要性，即使它们在临床和皮肤镜水平均表现为对称。
