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Decoding the Spitz Puzzle: Histological Patterns and Diagnostic Challenges in Everyday Pathology Practice-A
Iuliu Gabriel Cocuz1,2, Georgian-Nicolae Radu2, Maria Cătălina Popelea2,3
1Pathophysiology Department, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania.
Medicina (Kaunas, Lithuania)
|August 28, 2025
Summary
Spitz tumors are challenging to diagnose. This study highlights that clinical-morphological assessment with immunohistochemistry is crucial for accurate diagnosis, especially when molecular testing is unavailable, confirming most lesions are benign.
Area of Science:
- Dermatopathology
- Oncology
- Histopathology
Background:
- Spitz tumors present diagnostic challenges due to morphological variability and overlap with malignant lesions.
- Uncertainty in biological behavior necessitates integrated diagnostic approaches, particularly without molecular pathology.
- The WHO Classification of Skin Tumours provides a framework for evaluating these lesions.
Purpose of the Study:
- To evaluate epidemiological, macroscopic, and histopathological characteristics of Spitz lesions.
- To assess the utility of clinical-morphological assessment and immunohistochemistry in diagnosing Spitz lesions.
- To align findings with the WHO Classification of Skin Tumours criteria.
Main Methods:
- Retrospective, descriptive study of 10 Spitz tumors diagnosed between 2018-2024.
- Analysis of macroscopic features (localization, shape, dimension, color).
- Evaluation of microscopic characteristics (cell types, atypia, pagetoid migration, mitoses) and immunohistochemistry (Ki 67 index).
Main Results:
- Study population comprised young patients (average age 20.2 years), predominantly female.
- Most lesions were benign Spitz nevi (intradermal or compound) with specific cell shapes.
- Low Ki 67 proliferation index (<5%) and infrequent pagetoid migration/cytological atypia observed.
Conclusions:
- Clinical-morphological assessment combined with immunohistochemistry is vital for diagnosing Spitz lesions without molecular testing.
- The study confirms the predominantly benign nature of the evaluated Spitz lesions.
- Results support a multidisciplinary approach, including molecular testing, for future research.
