Few benign melanocytic lesions encountered in clinical practice elicit the level of controversy as that generated by lesions within the spectrum of Spitz nevi. Unlike melanoma, the dermoscopic structures found in Spitz nevi tend to be distributed in a symmetric and organized manner. This review highlights the melanoma-specific structures and patterns commonly seen in Spitz nevi. Knowledge of the dermoscopic structures and patterns encountered in Spitz nevi (particularly the classic symmetric starburst pattern), together with understanding of their growth dynamics, can inform the decision whether to biopsy or monitor.