Clinical features and outcomes of spitzoid proliferations in children and adolescents

Br J Dermatol. 2019 Aug;181(2):366-372. doi: 10.1111/bjd.17450. Epub 2019 Feb 10.


Background: Spitzoid proliferations range from Spitz naevi to melanomas. There are few studies describing clinical features and outcomes in the paediatric population.

Objectives: To determine the clinical features and outcomes of a large paediatric cohort with histopathologically confirmed Spitz tumours.

Methods: This was a retrospective cohort study of patients seen at Boston Children's Hospital who were aged < 20 years and had a histopathological diagnosis of spitzoid proliferation from 1 January 1994 to 23 October 2012.

Results: In total 595 patients with 622 spitzoid proliferations were identified (median age 7·4 years, interquartile range 4·6-11·7). Overall 512 proliferations (82·3%) were typical, 107 (17·2.%) were atypical and three (0·5%) were melanomas. The median ages at biopsy were 7·4, 7·2 and 17·2 years, respectively, and there was a significant difference in age at biopsy for patients with typical or atypical proliferations vs. melanoma (P < 0·01). Among samples with positive margins (n = 153), 55% (54 of 98) of typical proliferations, 77% (41 of 53) of atypical proliferations and 100% (two of two) of melanomas were re-excised. Six patients had sentinel lymph node biopsy performed, with three patients demonstrating nodes positive for melanocytic cells. Within a median follow-up of 4·1 years for the full cohort there were no related deaths.

Conclusions: Spitz tumours have strikingly benign outcomes in the paediatric population, although this study is limited by the low number of melanomas and restriction to a single paediatric institution. Aggressive management recommendations should be reconsidered for children and adolescents with banal-appearing Spitz naevi, based on the clinically indolent behaviour in this cohort.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Biopsy
  • Cell Proliferation
  • Child
  • Child, Preschool
  • Diagnosis, Differential
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Melanoma / diagnosis*
  • Melanoma / epidemiology
  • Melanoma / pathology
  • Melanoma / therapy
  • Nevus, Epithelioid and Spindle Cell / diagnosis*
  • Nevus, Epithelioid and Spindle Cell / epidemiology
  • Nevus, Epithelioid and Spindle Cell / pathology
  • Nevus, Epithelioid and Spindle Cell / therapy
  • Retrospective Studies
  • Sentinel Lymph Node Biopsy
  • Skin / diagnostic imaging
  • Skin / pathology*
  • Skin Neoplasms / diagnosis*
  • Skin Neoplasms / epidemiology
  • Skin Neoplasms / pathology
  • Skin Neoplasms / therapy
  • Treatment Outcome
  • Young Adult