Junctional, compound or dermal nevus, composed of epithelioid melanocytes (large, with broad, pink cytoplasm, sometimes multinuclear). Compound Spitz nevi show often mitotic activity.

Intraepidermal melanocytes are organized in nests and in single units and often epidermal scatter is present. Melanocytes are (at least focally) spindle-shaped, running parralelly. The amount of melanin is usually low. The extent of intraepidermal component does not extend beyond the dermal part. The melanocytes mature towards the base of the nevus.

Epidermis is hyperplastic, granular layer is focally increased. Eosinophilic globules (Kamino bodies) are sometimes present. Within the nevus is usually slight lymphocytic infiltrate.

The shape of the lesion is symmetric, the bottom is usually flat, lateral borders are sharp. Junctional nests of melanocytes are often separated by clefts from surrounding epidermis. Some Spitz nevi may be desmoplastic or show hyalinization.