ConditionSkin, hair & nails
Spitz Nevus
A Spitz nevus is an uncommon, benign type of mole that usually appears in children and young adults as a smooth, dome-shaped, pink, red or reddish-brown bump, most often on the face or legs. It can grow quickly over a few months, which is alarming, and under the microscope it can look similar to melanoma. Most are harmless, but because of this overlap, doctors often recommend removing them, especially in adults. Atypical Spitz tumors sit in a gray zone and are usually removed with clear margins and followed up.
Also called: Spitz mole, Spitz naevus, spindle and epithelioid cell nevus, benign juvenile melanoma (outdated)
At a glance
- What it is
- A benign mole made of large spindle- or epithelioid-shaped pigment cells.
- Who gets it
- Mostly children and adolescents; less common in adults.
- Appearance
- Pink, red or brown dome-shaped bump; sometimes dark ("pigmented Spitz" or Reed nevus).
- Concern
- Can look like melanoma clinically and under the microscope.
- Management
- Monitoring in young children with typical lesions; removal for atypical, changing or adult lesions.
When to get help
See a doctor within a day or two
- A rapidly growing, bleeding or ulcerated bump on the skin, especially in an adult
- A new mole with irregular shape, multiple colors or rapid change in someone over 12
Book a routine appointment
- A new pink, red or brown dome-shaped bump in a child, to confirm what it is
- A known Spitz nevus that changes in size, color or shape, or bleeds
- A swollen lymph node near a previously removed Spitz or atypical Spitz tumor
Usually safe to manage at home
- A small, stable, symmetrical Spitz nevus in a young child, already assessed by a dermatologist and being monitored
What it looks like
- a smooth, round, dome-shaped papule or nodule
- pink, red, tan or reddish-brown; less often dark brown or black
- usually under 1 cm (0.4 in)
- often on the face, especially cheeks, or the legs
- may grow quickly over months, then stabilize
- usually painless; may bleed if scratched
A Reed nevus (pigmented spindle cell nevus) is a dark variant, often on the thigh of young women, with a starburst pattern on dermoscopy.
Spitz nevus vs other spots
| Lesion | Features |
|---|---|
| Spitz nevus | Pink to brown dome, symmetric, children |
| Melanoma | Irregular shape and color, growing, more common in adults; nodular melanoma can be pink |
| Pyogenic granuloma | Bright red, bleeds easily, often after injury |
| Hemangioma | Red, soft, compressible; appears in infancy |
| Juvenile xanthogranuloma | Yellow-orange bump in young children |
| Common mole | Flat or raised brown spot, even color |
Causes
Spitz nevi are caused by genetic changes in the mole cells, such as HRAS mutations or fusions involving kinase genes (ALK, ROS1, NTRK and others). These are acquired, not inherited, and do not mean a family risk.
Diagnosis
- dermoscopy: often shows a symmetric "starburst" or globular pattern with dotted blood vessels in pink lesions
- biopsy: usually complete removal (excisional biopsy) so the whole lesion can be examined
- dermatopathology review, sometimes with expert second opinion
- molecular tests (FISH, gene expression or sequencing) for ambiguous lesions
Pathologists classify lesions as:
- Spitz nevus: benign
- atypical Spitz tumor (Spitz melanocytoma): uncertain behavior; most behave benignly but can occasionally spread to nearby lymph nodes
- Spitz melanoma: malignant
Treatment
Children
For young children with a small, symmetric, classic-looking Spitz nevus, many dermatologists recommend monitoring with photographs and dermoscopy every few months. Many Spitz nevi stabilize and some fade over time. Removal is advised if the lesion is atypical, keeps growing, bleeds, or causes concern.
Adolescents and adults
Because Spitz-like lesions in adults are more likely to be melanoma, complete excision with a small margin is usually recommended.
Atypical Spitz tumors
- complete excision with clear margins
- sentinel lymph node biopsy is not routinely recommended but may be discussed in some cases
- regular skin and lymph node checks
Outlook
Typical Spitz nevi are benign and carry an excellent prognosis. Atypical Spitz tumors in children generally do very well even when nearby lymph nodes are involved. Ongoing skin checks and sun protection are recommended.
Frequently asked questions
Is a Spitz nevus cancerous?
No. A Spitz nevus is a benign mole. However, it can look like melanoma both on the skin and under the microscope, so doctors examine it carefully and often remove it, especially in adolescents and adults.
What does a Spitz nevus look like?
It usually appears as a smooth, round, dome-shaped bump that is pink, red or reddish-brown, often on the face or legs of a child. Some are darker. They may grow quickly at first, then stop growing.
Should a Spitz nevus be removed?
In young children with classic features, monitoring may be enough. Removal is recommended for lesions that are atypical, growing, bleeding, or in adolescents and adults. A dermatologist will advise based on age and appearance.
What is an atypical Spitz tumor?
It is a Spitz-type lesion with features between a benign Spitz nevus and melanoma. Most behave benignly. It is usually removed completely with clear margins and followed with regular skin and lymph node checks.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Dermatology: Moles: who gets and types
- DermNet: Spitz naevus
- American Osteopathic College of Dermatology: Spitz nevus
- National Cancer Institute: Common moles, dysplastic nevi, and risk of melanoma
- Skin Cancer Foundation: Atypical moles