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Dermoscopy and Management of Spitz Naevi
This month we bring you a very important study on Spitz naevi from Dr Aimilios Lallas (Aristotle University Thessaloniki) and colleagues. Aimilios is a key contributor – and terrific lecturer in the HealthCert online dermoscopy courses.
In this paper, Aimilios and his colleagues bring some order and clarity to the diagnosis and management of Spitz nevi. The key challenge here, for GPs in primary care especially, is to decide whether a lesion is a Spitz nevus (benign) or a melanoma that looks like a Spitz nevus. This is the sort of thing that terrifies GPs!
In their section on “What this study adds” the authors state the following (we have adjusted it slightly to make it absolutely clear what we as GPs need to know, and do):
Three dermoscopic patterns may be considered as suggestive of a Spitz naevus: starburst pattern, regularly distributed dotted vessels and globular pattern with reticular depigmentation.
Dermoscopically asymmetric lesions with spitzoid features (both flat/raised and nodular) should be excised to rule out melanoma, at any age.
Dermoscopically symmetric spitzoid nodules should also be excised at any age, to rule out atypical Spitz tumours.
Dermoscopically symmetric flat spitzoid lesions can be observed closely if aged <12 years, and should be excised >=12 years due to the risk of melanoma.
Clear, simple rules that we can all understand and apply.
Professor David Wilkinson
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