Spitzoid Melanoma in Children and Adults: Prognosis, Symptoms

Spitzoid melanoma is the Scarlet Pimpernel of the melanoma tribe. It is elusive and histologically appears indistinguishable to benign skin lesions – Spitz Naevus, Haemangioma or Basal Cell Carcinoma. First catalogued in 1910 by Darrier and Civatte, they acquired their current name when Sophie Spitz, an American pathologist, captured their defining criteria in 1948. Spitzoid melanoma does not conform to the ABCD guide which medics use for regular melanoma – Asymmetry – it is often uniform, Border irregularity – they can be smooth and round – Colour variation and Diameter. They are tricky to identify and often erroneously labelled or missed altogether.

What is the difference between Spitzoid Melanoma and Spitz Nevus?

Spitz Nevus is non-cancerous skin growth. Advances in histology and interpretative techniques have demonstrated these are harmless. They are most commonly seen in children and young people aged below twenty years. Spitz Nevus or the plural, Nevi, are also termed, Spitz moles, and are characterised by their rapid growth.

They may be tiny in diameter or alternatively large, reaching several centimetres. Classically, they feature a dome shape and may demonstrate traditional red/brown or reddish/pink colouration but they can buck the trend and be transparent. The critical issue is the accurate establishment of the type of Spitz mark and this requires expert evaluation by a dermatologist.

What is the diagnostic protocol for a Spitzoid Melanoma?

Diagnostically, a Spitzoid melanoma is analysed by biopsy as standard protocol, the challenge arising when the clinician attempts to differentiate the histology and cytology from non-malignant spitzoid or other unoffending blemishes. Generally, spitzoid melanoma presents as a nodule or papule, either de novo – medically meaning new – or emerging from a current Spitz Nevus, also described as Naevus. Shading varies, if pigmented they can be dark brown, blue or black or pale, nearly transparent and colourless. Advanced presentations can be ulcerated or crusty. Here are some pictures to aid identification. Don’t fall into the trap of using the internet as a doctor. Any lump, lesion or alteration on your skin needs prompt clinical attention and appropriate referral to a skin specialist if remotely suspicious or unidentifiable.

Is Spitzoid melanoma more common in children?

Branded as paediatric or juvenile occurrences, Spitzoid melanoma is the commonest type of skin cancer in children. Appearances can be deceptive, however. Spitzoid melanoma is not increasing statistically although that might seem the obvious conclusion. Rather, scrutiny is more focused in recent years on identification and accurate diagnosis in the youth. Successful referrals suggest higher numbers but children have in fact been somewhat overlooked with previously, the focus almost exclusively on adults. However, significantly rising numbers in young teens are undoubtedly coming to light attributable to tanning bed usage. This has led to 42 American states either restricting adolescent tanning services or banning them in their entirety. The Skin Cancer Foundation’s research has concluded that use of a tanning bed or cubicle before the age of 35 increases the possibility of contracting melanoma by an enormous 75%! That is a higher risk than the correlation between lung cancer and smoking cigarettes. With spray tans now so sophisticated – forget the caked on orange gunk of yesteryear, a colour that made you look more like a space alien than an attractive human – it begs the question why anyone would play Russian Roulette with their lives for the sake of perceived beauty.

The good news about Spitzoid melanoma in children is that they are highly curable. Treatment is virtually identical to that offered to adults with the same condition.

Spitzoid melanoma in adults

Unlike other skin melanomas which tend to affect older people with a lifetime’s exposure to the sun’s harmful rays, spitzoid melanoma is less likely to occur as age increases. The prescribed treatment for spitzoid melanoma in adults is the same as for other melanomas – surgery to remove the melanoma plus a margin of healthy tissue and regular monitoring for recurrence.

What is the prognosis for someone with a Spitzoid Melanoma?

Scientific data on the longevity of outcomes and mortality rate is poor because this is not a commonly diagnosed disease. Studies can only sample fairly low numbers and produced mixed results. Some have suggested that spitzoid melanoma are less aggressive than conventional skin melanomas whereas have maintained the contrary.

Add to this a general lack of recognition amongst diagnosing doctors and a lack of industry-wide evaluation tools and it is evident just how hard it is to capture meaningful data about numbers of diagnoses and subsequent conclusions. As an average, it would seem, however, that survival figures at ten years’ post-operation are nearly 100%.

How to avoid Spitzoid Melanoma?

As with all skin melanomas, stay out of the sun. Shade is the biggest determinant factor in avoiding any skin cancer. There is a lot of misinformation out there in the public domain particularly surrounding Vitamin D. Vitamin D is an essential component for vibrant health, produced in the human body by the action of sunlight on the skin. It is a fallacy and laughably counterintuitive to state however that high levels of Vitamin D, ironically gained by overexposure to sunlight, will boost your natural defences against melanoma. In much the same way, the response to egg plant or aubergines topically curing melanomas should be guarded. Time is of the essence with undiagnosed skin complaints and proper medical confirmation and action are critical before alternative options can be pursued.

 

 

Article References:

  1. https://jamanetwork.com/journals/jamadermatology/article-abstract/1814821
  2. https://www.dermnetnz.org/topics/spitzoid-melanoma/
  3. https://www.medicalnewstoday.com/articles/320805.php
  4. https://www.fitnessmagazine.com/health/conditions/ban-tanning-beds/
  5. https://www.vitamindcouncil.org/about-vitamin-d/how-do-i-get-the-vitamin-d-my-body-needs/#.XNMk4jBKjIU
  6. https://articles.mercola.com/sites/articles/archive/2011/12/10/vitamin-d-exposure-possible-natural-cure-for-skin-cancers.aspx

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