The Diagnosis and Management of the Spitz Nevus in Children: A Systematic Review, Meta-Analysis, and Review of Canadian Practice

• Published in: Canadian journal of plastic surgery Vol. 25; no. 2; p. 133
• Main Authors: Stein, M, Abboud, J, Bahubeshi, A, Ramien, M, Malic, C
• Format: Journal Article
• Language: English
• Published: Montreal SAGE PUBLICATIONS, INC 01.07.2017
• Subjects: Dermatology; Meta-analysis; Systematic review; Canada
• ISSN: 2292-5503; 2292-5511

Purpose: To date, there exists no guidelines for the management of Spitz Nevi in children (Typical-TSN or Atypical-ASN). Due to their low incidence, the diagnosis and management of such tumors, especially ASN, lack consensus among plastic surgeons, dermatologists, and pathologists. The objective of this study was to perform a systematic review and meta-analysis of existing literature and to evaluate current management protocols among plastic surgeons and dermatologists across Canada. Methods: Ethics approval (CHEO#17/13X) was granted for an electronic search from inception to December 2016 as per PROSPERO guidelines. An 11-question, scenario-based survey was distributed to plastic surgeons and dermatologists across Canada to appreciate current practices. Results: Of 630 studies screened, 135 were considered for review. The cumulative data from 3803 TSN and 579 ASN demonstrates similar body distribution, pigmentation and mortality rates but an appreciable increase in both diameter and elevation for ASN. ASN are also more likely to have epidermal invasion, ulceration, atypical mitosis, higher Clark level, and increased recurrence after excision. The pan-Canadian survey (N = 90) demonstrates that plastic surgeons tend to excise TSN while dermatologists tend to observe conservatively. Both groups agreed that age was the main determinant directing intervention, with 11-12 being the threshold age where management transitioned from conservative to surgical. If a histopathologic diagnosis of an ASN was made, there is agreement to reexcise the scar with >2 mm margins, even if <11 years old. Conclusions: This study offers the most comprehensive review of Spitz Nevi in the pediatric population to date. Contrasting the clinical, histopathologic, and dermoscopic features of all published TSN and ASN is essential to inform a diagnosis and management approach. This study will assist in the development of a diagnostic and treatment algorithm. Learning Objectives: Participants will be able to identify clinical/histological/dermoscopic features of typical and atypical Spitz Nevi and propose an appropriate management plan.