Since their first description by Sophie Spitz, Spitz nevi have been a subject of controversy among clinicians for many decades, and remain a clinical conundrum until today as their etiology, morphology, biological behavior and natural evolution is still not totally clear. This is because their clinical, dermoscopic and histopathologic features sometimes overlap with those of melanoma, rendering the management of spitzoid lesions particularly difficult. In addition, cases of histopatologically equivocal lesions do exist and their classification might sometimes be very challenging. Among several terms that have been used to describe these morphologically "intermediate" lesions, atypical Spitz tumor (AST) is the most widely used. The aim of this review paper was to describe the dermoscopic patterns and structures seen in Spitz/Reed nevi, spitzoid melanoma and AST. Finally, this article provides an evidence-based update on the available options for the management of spitzoid lesions, before and after histopathologic diagnosis.