Beijnen Usha E A, Walsh Landis R, Nuzzi Laura C, Schmidt Birgitta A R, Labow Brian I, Taghinia Amir H
Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
Plast Reconstr Surg Glob Open. 2020 Dec 18;8(12):e3244. doi: 10.1097/GOX.0000000000003244. eCollection 2020 Dec.
Proper management of Spitz nevi continues to be debated, with treatment ranging from observation to surgery. To better characterize the outcome of surgical procedures performed for incomplete initial excision or biopsy, we sought to ascertain the histopathological presence of residual Spitz nevi in a set of surgical specimens.
We retrospectively reviewed 123 records with histologically-confirmed Spitz nevus. Data concerning treatment, clinical features, histopathological margin involvement, and presence of residual lesion on subsequent procedural specimens were collected.
Fifty-three percent of lesions (n = 65) were initially sampled by shave or punch biopsy, and the remainder (n = 58) were formally excised without initial biopsy. The rates of re-excision for involved margins were: shave biopsy (92.2%), punch biopsy (78.6%), and formal excision (13.8%). In total, 61.0% of patients who underwent an initial procedure of any kind had involved margins, but only half of those re-excised for involved margins (57.6%) had histologically residual lesion on repeated excision. A significantly higher proportion of initial punch biopsies (90.9%) resulted in residual lesion (in secondary excision specimens) when compared with shave biopsy (48.9%) and formal excision (62.5%; < 0.05).
Findings suggest that clinicians may consider shave biopsy over punch biopsy for diagnosing suspected lesions, when indicated and appropriate. Given the rarity of malignant transformation and the frequency of residual nevus, observation may be reasonable for managing pediatric patients with histologically-confirmed Spitz nevi, who are post initial biopsy or excision despite known histopathological margin involvement.
Spitz痣的恰当管理仍存在争议，治疗方法从观察到手术不等。为了更好地描述因初次切除不完全或活检而进行的外科手术的结果，我们试图确定一组手术标本中残留Spitz痣的组织病理学情况。
我们回顾性分析了123例经组织学确诊为Spitz痣的病例记录。收集了有关治疗、临床特征、组织病理学切缘受累情况以及后续手术标本中残留病变情况的数据。
53%的病变（n = 65）最初通过刮除或钻孔活检取样，其余（n = 58）则未进行初始活检而直接完整切除。切缘受累的再次切除率分别为：刮除活检（92.2%）、钻孔活检（78.6%）和完整切除（13.8%）。总体而言，接受任何一种初始手术的患者中有61.0%切缘受累，但因切缘受累而再次切除的患者中只有一半（57.6%）在再次切除时组织学上有残留病变。与刮除活检（48.9%）和完整切除（62.5%；P < 0.05）相比，初始钻孔活检导致残留病变（在二次切除标本中）的比例显著更高（90.9%）。
研究结果表明，在有指征且合适时，临床医生在诊断疑似病变时可考虑选择刮除活检而非钻孔活检。鉴于恶性转化罕见且残留痣常见，对于组织学确诊为Spitz痣、初次活检或切除后尽管已知组织病理学切缘受累的儿科患者，观察可能是合理的管理方式。
