School of Clinical Medicine, University of Cambridge, UK.
Plastic Surgery Unit, Addenbrooke's Hospital, Hills Rd, Cambridge, UK.
J Plast Reconstr Aesthet Surg. 2024 Oct;97:282-286. doi: 10.1016/j.bjps.2024.07.031. Epub 2024 Jul 27.
No definitive management guidelines exist for Spitz-type lesions; recommendations in the UK favour a 'safe' approach with a low threshold for excision. We aimed to describe Spitz-type lesions in children to further clarify the clinical features and outcomes.
We conducted a retrospective cohort study in Addenbrooke's Hospital, Cambridge, UK, and reviewed all patients aged ≤18 years with histologically confirmed Spitz-type lesions from November 2014 to September 2020. Information collected included patient demographics, lesion details, follow-up, outcomes and recurrence.
Ninety-one children (male: female 42: 49; mean age at diagnosis: 9.4 years, SD: 4.6 years) were identified. Among them, 64 (70.3%) had classic Spitz or spitzoid naevi, 26 (28.6%) atypical Spitz tumours and 1 (1.1%) had spitzoid malignant melanoma based on histological features. On assessing the clinical features, where documented, we found that 22.0% (20/91) had amelanosis, 44.0% (40/91) had a raised bump, 12.1% (11/91) displayed bleeding, 25.0% (20/80) had non-uniform colour, 96.7% (88/91) were de novo lesions, 55.1% (43/78) were evolving in size and 35.9% (28/78) were evolving in colour. Fifty-nine patients (64.8%) were discharged without the need for follow-up, and the other 32 had a median follow-up time of 4 months. After confirmed excision, no incidences of local recurrence, distant metastases or mortality have been reported to date in all patients.
The outcomes for paediatric Spitz-type lesions continue to be exceptionally good, remaining a low-risk lesion, which is more likely to be benign in children. Hence, we do not advocate aggressive management strategies for paediatric patients with clinically banal Spitz-type lesions.
对于 Spitz 型病变，目前尚无明确的管理指南；英国的建议倾向于采取“安全”的方法，切除的门槛较低。我们旨在描述儿童中的 Spitz 型病变，以进一步阐明其临床特征和结局。
我们在英国剑桥的 Addenbrooke's 医院进行了一项回顾性队列研究，回顾了 2014 年 11 月至 2020 年 9 月期间所有经组织学证实为 Spitz 型病变且年龄≤18 岁的患者。收集的信息包括患者人口统计学、病变详细信息、随访、结局和复发情况。
共确定了 91 名儿童（男：女 42:49；诊断时的平均年龄：9.4 岁，标准差：4.6 岁）。其中，64 名（70.3%）为典型 Spitz 痣或 Spitz 样痣，26 名（28.6%）为非典型 Spitz 肿瘤，1 名（1.1%）为组织学特征为 Spitz 样恶性黑色素瘤。在评估临床特征时，我们发现有 22.0%（20/91）的病变无色素沉着，44.0%（40/91）的病变呈隆起性丘疹，12.1%（11/91）的病变有出血，25.0%（20/80）的病变颜色不均匀，96.7%（88/91）的病变为新发病变，55.1%（43/78）的病变在大小上进展，35.9%（28/78）的病变在颜色上进展。59 名患者（64.8%）无需随访即出院，其余 32 名患者的中位随访时间为 4 个月。在确诊切除后，目前所有患者均未报告局部复发、远处转移或死亡。
儿科 Spitz 型病变的结局仍然非常好，仍然是一种低风险病变，在儿童中更可能是良性的。因此，我们不主张对临床上看似良性的儿童 Spitz 型病变采取激进的治疗策略。
