Clinical features of Spitz naevus in children: A retrospective study of 196 cases

Aims. - To better define the characteristics of Spitz naevus (SN) in children, to determine whether it was clinically diagnosed and to examine the differential diagnoses made according to age. In addition, to determine whether atypical spitzoid tumors (AST) have a different presentation from other forms of SN. Patients and methods. - A two-centre retrospective survey was made of histopathological reports written over a 4-year period in children aged under 18 years. The inclusion criterion was unequivocal diagnosis of SN or AST. Age, gender, site, size, course, excision methods, presumptive clinical diagnoses and the percentage of correct diagnosis were analyzed for four distinct age groups. Results. - One hundred and ninety-six patients were included, 186 with SN and 10 with AST. Mean age at diagnosis of SN was 9 years. Female predominance and predilection for the lower limbs were seen for all age groups. Facial involvement was less frequent and chiefly affected children aged under 11 years. Most SN lesions measured between 4 and 8 mm. They were often confused with either pyogenic granuloma or juvenile xanthogranuloma, mainly before the age of 11 years. An accurate diagnosis was made in 29% of cases, chiefly in the 0 to 5 year-old age group. No cases of AST were clinically recognized, but it was diagnosed occasionally on histological grounds for very small tumours and in very young children. Conclusion. - Clinical diagnosis of SN is not always straightforward and in this study, AST exhibited no special features allowing it to be distinguished from SN. These results underline the need for caution in the event of SN in children, regardless of age or lesion size. (C) 2012 Elsevier Masson SAS. All rights reserved.