Even when "atypical Spitz tumors" metastasized, Barnhill and colleagues continued to trumpet the idea that the neoplasm really were Spitz's nevi and not melanomas. They did this repeatedly in words such as these:

In a sense, all of the nevi reported on in 1948 by Spitz were "atypical," so atypical, in fact, that she misinterpreted them as melanomas. Yet, in another sense there is no place in this context for the modifier "atypical"; a Spitz's nevus is a Spitz's nevus and a melanoma is a melanoma. Words like "atypical," "borderline," "minimal deviation," and "nevoid" are hedges against a histopathologist rendering a diagnosis with specificity. In the case of Barnhill's "atypical Spitz tumor," the diagnosis is melanoma; the neoplasm metastasized! If one is uncertain about a diagnosis, it is best to state that directly rather than resorting to opaque circumlocutions, such as "melanocytic neoplasm of uncertain biologic potential." The biologic potential from the vantage of the neoplasm is certain; it is uncertain only from the viewpoint of the histopathologist. And as parenthesis to this precept, the job of a histopathologist is to make a diagnosis with precision in the language of clinical medicine; it is not to speculate about prognosis in the manner of a diviner, seer, or prophet.