Peer Reviewed


Spitz Nevus in a Nevus Spilus: Management Considerations in Pediatric Patients

Rachel L. Flint, MD1 • Aaron S. Cantor, MD2

1Department of Graduate Medical Education, Tripler Army Medical Center, HI
2Department of Dermatology, Naval Medical Center, Portsmouth, VA

Flint RL, Cantor AS. Spitz nevus in a nevus spilus: management considerations in pediatric patients. Consultant. 2023;63(5):e7. doi:10.25270/con.2023.03.000005

Received September 23, 2022. Accepted January 12, 2023. Published online March 21, 2023.

The authors report no relevant financial relationships.


The authors report that informed patient consent was obtained for publication of the images used herein.


Rachel L. Flint, MD, Department of Graduate Medical Education, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859 (

Case presentation. A 4-year-old girl presented to the dermatology clinic with a 9 mm firm, nontender, well-circumscribed dome-shaped pruritic pink papule on her anterior left thigh. The papule was eccentrically located within a 4 cm tan ovoid patch with several darker brown macules, consistent with a nevus spilus (Figure 1).

Figure 1. A 9 mm firm, nontender, well-circumscribed, dome-shaped pruritic pink papule eccentrically located within a 4 cm tan, ovoid patch with several darker brown macules on the anterior left thigh.

Patient history. Her medical and family history was not significant for skin cancer. While the nevus spilus had been present since infancy and was previously tracked as a café-au-lait macule, the new pink papule developed within the past year, prompting her referral to a dermatologist.

Diagnostic testing. Dermatoscopy of the papule showed an asymmetric distribution of dotted spiral vessels surrounded by orthogonal shiny white lines (Figure 2). No inguinal lymphadenopathy was present. The differential diagnosis included Spitz nevus, melanoma, hemangioma, mastocytoma, and lymphocytoma.