Management of Spitz nevi: A survey of dermatologists in the United States Journal Article

Authors: Gelbard, S. N.; Tripp, J. M.; Marghoob, A. A.; Kopf, A. W.; Koenig, K. L.; Kim, J. Y.; Bart, R. S.
Article Title: Management of Spitz nevi: A survey of dermatologists in the United States
Abstract: Background: There is no consensus concerning management of Spitz nevi. Objective: This study was carried out to ascertain how dermatologists manage Spitz nevi. Methods: A questionnaire was sent to 997 fellows of the American Academy of Dermatology, 284 pediatric dermatologists, and 27 directors of pigmented-lesion clinics. The results are based on the 381 questionnaires returned. Results: The vast majority of responding dermatologists (93%) recommend biopsies of suspected Spitz nevi. Of this group, 43% recommend total biopsies and 55% recommend partial biopsies; 2% would recommend either total or partial biopsies, depending on the clinical situation. Sixty-nine percent of physicians would completely excise a lesion that was histologically diagnosed as an incompletely removed Spitz nevus. Seventy percent of general dermatologists and 80% of pediatric dermatologists would recommend excision with a 1- to 2-mm margin of normal-appearing skin around a Spitz nevus. Nine percent of general dermatologists would recommend margins of 4 mm or more; however, all pediatric dermatologists surveyed would recommend margins less than 4 mm. Physicians were less likely to monitor patients whose Spitz nevi were completely removed. Three fourths (740%) of respondents believe Spitz nevi are entirely benign, 4% believe they are precursors to melanoma, and 22% are not sure. Seven percent of general dermatologists and 4% of pediatric dermatologists have seen metastatic melanomas arise at sites of lesions initially diagnosed histologically as Spitz nevi; 40% of pigmented-lesion clinic directors have seen such lesions. Conclusions: We believe that the lack of consensus, both in our survey and in the medical literature, reflects to some extent the lack of certainty in the histologic differentiation of Spitz nevi from melanomas and that concern about melanoma influences management. At the pigmented-lesion clinic of the New York University Skin and Cancer Unit, because of this concern about melanoma, it is usually recommended that Spitz nevi be completely excised.
Keywords: child; excision; united states; cancer diagnosis; clinical practice; physician's practice patterns; melanoma; skin biopsy; skin neoplasms; diagnosis, differential; histology; juvenile melanoma; medical specialist; physician; nevus, epithelioid and spindle cell; dermatology; health care surveys; humans; human; priority journal; article
Journal Title: Journal of the American Academy of Dermatology
Volume: 47
Issue: 2
ISSN: 0190-9622
Publisher: Mosby Elsevier  
Date Published: 2002-08-01
Start Page: 224
End Page: 230
Language: English
DOI: 10.1067/mjd.2002.121031
PUBMED: 12140468
PROVIDER: scopus
Notes: Export Date: 14 November 2014 -- Source: Scopus
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MSK Authors
  1. Ashfaq A Marghoob
    392 Marghoob