The epithelioid cells are bizarrely shaped, show poor cohesion, often have several nuclei, and frequently have multiple large nucleoli. Another important feature is the maturation of cellular elements toward the dermis. Pagetoid spread of the melanocytes is usually confined to the center of the lesion, when present it can cause confusion with melanoma. The epidermis is hyperkeratotic and acanthotic. A cleavage artifact of fixation commonly is noticed above the nests and around superficial dermal elements.
Activity is restricted only to the extent that the surgical procedure justifies.
The only complications are those that may occur after any surgical excision and repair. The prognosis is good. Recurrences should be treated with re-excision. Educate patients about sun protection and self-examination of the skin. Criteria that in concert strengthen the probability of the diagnosis of Spitz nevus in any given case include a young patient, a well-demarcated and symmetrical lesion, maturation of melanocytes at its base, and the presence of epithelial hyperplasia, but no criterion is absolutely reliable.