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Comment & Response
January 9, 2018

Dermoscopic Patterns of Spitz Nevi—Reply

Author Affiliations
  • 1Department of Dermatology, Peking Union Medical College Hospital, Beijing, China
JAMA. 2018;319(2):194. doi:10.1001/jama.2017.18999

In Reply We agree with Dr Pollock that Spitz nevi can mimic melanoma at the clinical, histologic, and dermoscopic levels, and it is important to know all of the dermoscopic patterns of Spitz nevi. The patient in our case did not have a dermoscopic examination, and the diagnosis was made according to the clinical, histopathologic, and immunochemical manifestations. Therefore, we mentioned only the 2 main dermoscopic patterns of Spitz nevi in the discussion.

According to Stefanaki et al, the dermoscopic findings of Spitz nevi depend on the type of nevus and whether it is pigmented.1 In nonpigmented Spitz nevi, 5 patterns have been identified, whereas in pigmented Spitz nevi, 4 patterns have been described. The nonpigmented nevi can have a homogenous pink color (with or without a brownish hue or remnants of brown pigmentation), dotted vascular pattern (pinpoint vascular dots), starburst vascular pattern (regular vascular lines extending to the periphery), reticular depigmentation (whitish net), or chrysalis structures (shiny linear streaks). The pigmented nevi usually exhibit a starburst pattern (central blue-black pigmentation and regular radial projections at the periphery), globular pattern (central blue-black pigmentation and large, brown-black, regular globules regularly distributed at the periphery), homogenous pattern, or multiple components.1,2 The presence of different dermoscopic patterns in Spitz nevi can change with the evolution of the lesions.3 All of the dermoscopic features of Spitz nevi can be suggestive of melanoma, and careful interpretation depending on the clinical, histopathologic, and immunochemical manifestations is warranted.1

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