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

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

Objectives: 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.

Methods: 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.

Results: 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).

Conclusions: 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.