Narrow-Margin Excision of Atypical Spitz Tumors: A Single-Center Retrospective Review

Atypical Spitz tumors (AST) represent a diagnostically challenging and biologically heterogeneous group of intermediate melanocytic tumors in children. Although recent expert consensus guidelines recommend narrow margin excision, objective outcome data supporting narrow excision margins remain limited. This study evaluates surgical management practices and clinical outcomes of AST treated at a tertiary academic center.

A retrospective, IRB-approved chart review was performed on patients < 18 years diagnosed with AST and treated surgically from 2012 to 2025 at Children's Wisconsin. Lesions demonstrating spitzoid morphology with atypical histopathologic features were included. Demographics, clinical features, surgical margins, molecular studies, and clinical outcomes were assessed. Narrow excision was defined as ≤ 3 mm.

Forty-three patients were included. Twenty patients (46.5%) were female, 23 (53.5%) were male. Mean age was 7.4 years (range 1-15). Mean follow-up was 53.3 months. Thirty-seven patients (86.0%) underwent narrow excision and 6 (14.0%) underwent wider excision with mean surgical margins of 2.1 mm and 6.0 mm, respectively. Four patients in the narrow excision group (10.8%) required re-excision, including 1 (2.7%) due to clinical recurrence; no re-excisions occurred after wide excision. Surgical complications occurred in 50% of patients following wide excision compared to 5.4% following narrow excision. No local or distant metastases or deaths were observed during the study period.

In our cohort, narrow excision of AST was commonly employed and associated with excellent short- to mid-term oncologic outcomes and low surgical morbidity. These findings provide supportive clinical outcome data aligning with current consensus recommendations favoring more narrow surgical management of AST in children.