A Pragmatic Approach: Pediatric Spitz-like Lesions

Nurse practitioners serving primary care pediatric patients frequently lack referral access to dermatology specialists. Deciding whether or not to biopsy Spitz-type lesions in children is particularly complex, with significant potential sequelae. Forming an accurate prebiopsy differential through dermoscopic examination, palpation, and history is essential. When atypical Spitz-like features warrant biopsy, diagnostic accuracy requires proper technique and expert dermatopathology assessment. The implications of misdiagnosing malignant melanoma in a Spitz tumor and vice versa are profound for young patients and parents, clinicians, pathologists, and society. Information regarding Spitz-like lesions, including clinical characteristics, biopsy rationale, histology, lymph node assessment, and malpractice litigation, is reviewed.