Management of Spitz nevi: A survey of dermatologists in the United States - 01/09/11
Correspondence: Alfred W. Kopf, MD, Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 550 First Ave, New York, NY 10016.
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 (74%) 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. (J Am Acad Dermatol 2002;47:224-30.)
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Funding sources: The Ronald O. Perelman Department of Dermatology, New York University School of Medicine; Joseph H. Hazen Foundation; Mary and Emanuel Rosenthal Foundation; Kaplan Comprehensive Cancer Center (Cancer Center Support Core Grant No. 5P30-CA-16087); Blair O. Rogers Medical Research Fund; the Rahr Family Foundation; and Stavros S. Niarchos Foundation Fund of the Skin Cancer Foundation. |
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Conflict of interest: None. |
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Reprints not available from authors. |
Vol 47 - N° 2
P. 224-230 - août 2002 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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