Clinical, Dermoscopic, and Histopathological Features of Spitzoid Lesions in Adult Patients: Insights from a...

Spitzoid lesions are a group of melanocytic tumors, including Spitz nevi, atypical Spitz tumors, and Spitz melanomas, that pose a considerable diagnostic challenge.

Our aim was to describe the clinical, dermoscopic, and histopathological characteristics of spitzoid melanocytic lesions in adult patients in our center and to find possible associations between certain clinical-dermoscopic characteristics and the diagnosis of melanoma.

We conducted a single-center retrospective study and included all cases of histopathologically-confirmed spitzoid melanocytic lesions diagnosed in adult patients between January 2012 and December 2022. We collected patient demographic characteristics and clinical, dermoscopic, and histopathological characteristics of the studied lesions.

Histopathological examinations of the 103 lesions included in the study revealed four Spitz melanomas (3.9%) and 99 non-melanomas, of which 92 were Spitz nevi (89.3%) and seven atypical Spitz tumors (6.8%). The association between lower limb localization and diagnosis of melanoma was statistically significant (4/4 vs 45/99 patients, P=0.048). A statistically significant association between raised and pigmented morphology and malignant histology was found (4/4 vs 37/99 lesions, P=0.0229). Dermoscopy revealed that a multicomponent pattern was significantly associated with a diagnosis of melanoma (100% vs 21.6%, P<0.01) and that a vascular pattern was significantly associated with atypical Spitz tumors (80% vs 28.8%, P=0.0343).

In our cohort, some clinical characteristics (lower limb location, greater size, pigmentation, and palpability) and dermoscopic patterns (multicomponent) were associated with a diagnosis of melanoma. Dermatologists should be careful whenever they encounter any spitzoid-looking lesions in adults, especially in cases of older patients.