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“Atypical” Spitz’s Nevus, “Malignant” Spitz’s Nevus, and “Metastasizing” Spitz’s Nevus: A Critique in Historical Perspective of Three Concepts Flawed Fatally

Mones, Joan M. DO; Ackerman, A. Bernard MD

Section Editor(s): Ackerman, A Bernard Editor

The American Journal of Dermatopathology: August 2004 - Volume 26 - Issue 4 - p 310-333
From Dermatopathology: Practical & Conceptual

Our purpose in undertaking this Arbeit was to review all articles published about “atypical” Spitz’s nevus, “malignant” Spitz’s nevus, and “metastasizing” Spitz’s nevus, to criticize them in a fashion that illuminates, and to come to conclusions compellingly about those subjects. We found that an overwhelming majority of neoplasms that claimed to be “atypical Spitz’s nevus,” “metastasizing Spitz’s nevus,” and “malignant Spitz’s nevus” were, in fact, melanomas (Table 1). Moreover, in our estimation, those designations, and variants of them, like “atypical Spitz’s lesion,” “atypical dermal melanocytic lesion with features of Spitz’s nevus,” “atypical Spitzoid melanocytic neoplasm,” and “problematic Spitzoid melanocytic lesion,” are mere evasions from a diagnosis, straightforwardly, of either Spitz’s nevus† or melanoma.‡ Diagnoses in pathology equally bogus are “minimal deviation melanoma,” “borderline melanoma,” “nevoid melanoma,” “potentially low-grade melanocytic neoplasm,” and “melanocytic lesion of uncertain biologic potential.” Rather than admit uncertainty forthrightly, those who employ circumlocutions like those just mentioned resort to linguistic maneuvers that, at first blush, seem to be “academic” and constructed in such a way as to appear to convey confidence, rather than tentativeness, on the part of a histopathologist. On further scrutiny, however, each of those clichés is revealed to be devoid of content. For example, “malignant” Spitz’s nevus and “metastasizing” Spitz’s nevus not only are contradictions in terms, but they are outrageous violations of fundamental principles of classic Virchowian pathology, and “atypical” Spitz’s nevus not only is a redundancy because the neoplasm was so atypical to Spitz, herself, she insisted (from the time she spawned the idea in 1948 2 through 1951 3) it was a “malignant melanoma,” but is abject intellectually, those who invoke it never setting forth, in clear-cut fashion, criteria for what constitutes a “typical” Spitz’s nevus in contradistinction to an “atypical” one.



From the Ackerman Academy of Dermatopathology, New York, New York. Dr. Mones is an Associate at the Ackerman Academy of Dermatopathology in New York City where Dr. Ackerman is Director.

*The history told in these pages is abbreviated because it is recounted in more elaborate form in an article by us that appeared in the first issue of Dermatopathology: Practical & Conceptual for 2002 under the heading, “Melanomas in Pre-Pubescent Children: Review Comprehensively, Critique Historically, Criteria Diagnostically, and Course Biologically”

© 2004 Lippincott Williams & Wilkins, Inc.