Atypical spitz nevi/tumors: Lack of consensus for diagnosis, discrimination from melanoma, and prediction of outcome

Barnhill, Raymond L.; Argényi, Zsolt B.; From, Lynn; Glass, L. Frank; Maize, John C.; Mihm, Martín C.; Rabkin, Michael S.; Ronan, Salve G.; White, Wain L.; Piepkorn, Michael

doi:10.1016/s0046-8177(99)90193-4

Cited by 403 publications

(332 citation statements)

References 23 publications

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“…Ulceration was identified in 1 of 95 Spitz nevi and in 14 of the 33 nodular melanomas. Mitotic activity was identified in 22 of 95 of the [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Of the 33 patients with nodular malignant melanoma, 17 did not experience metastasis, 5 patients were alive but had suffered metastases, and 11 patients died from complications related to metastatic melanoma.…”

Section: Resultsmentioning

confidence: 99%

“…[1][2][3] Although many Spitz nevi can readily be distinguished from nodular melanomas, there remains a subset of tumors for which a definitive diagnosis of Spitz nevus versus that of melanoma is not rendered with ease. [4][5][6] Of the benign histological mimics of melanoma, Spitz nevi are among the most important to be recognized because they often extend into the reticular dermis and have a tumor thickness that may provoke sentinel lymph node mapping if called melanoma. Although Spitz nevi are cured by local excision, the 5-year survival for patients with nodular melanoma involving the reticular dermis (level IV) is o50%.…”

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confidence: 99%

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TRPM1 (Melastatin-1/MLSN1) mRNA expression in Spitz nevi and nodular melanomas

et al. 2009

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The transient receptor potential cation channel, subfamily M, member 1 (TRPM1/Melastatin-1/MLSN-1) expression has been shown to have prognostic utility in the evaluation of primary cutaneous melanoma. We analyzed a series of spindled and epithelioid cell nevi (Spitz) and primary cutaneous nodular melanomas to determine whether the expression of TRPM1 mRNA may be useful in distinguishing between Spitz nevi and nodular melanomas and to further examine the patterns of TRPM1 mRNA expression in cutaneous melanocytic proliferations. Formalin-fixed, paraffin-embedded tissues from 95 Spitz nevi and 33 nodular melanomas were analyzed for the expression of TRPM1 mRNA by in situ hybridization using 35 S-labeled riboprobes. Ubiquitous melanocytic expression of TRPM1 mRNA was observed in 56 of 95 (59%) Spitz nevi and 4 of 33 (12%) nodular melanomas. Diffusely scattered loss of TRPM1 mRNA was identified in 38 of 95 (40%) Spitz nevi and 2 of 33 (6%) nodular melanomas. Regional loss of the TRPM1 mRNA expression by a significant subset of dermal tumor cells or a complete absence of TRPM1 expression by the dermal tumor was identified in 27 of 33 (82%) nodular melanomas, but only 1 of 95 (1%) Spitz nevi. These findings suggest that the pattern of TRPM1 mRNA expression may be helpful in the differentiation of Spitz nevi and nodular melanomas. Of the 16 patients who experienced metastasis, 15 (94%) had primary tumors that displayed reduced MLSN mRNA expression by all or a part of the dermal tumor.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

TRPM1 (Melastatin-1/MLSN1) mRNA expression in Spitz nevi and nodular melanomas

et al. 2009

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“…19,20 These figures vary with the subset of melanocytic lesions under discussion, with the particularly treacherous Spitzoid melanomas and atypical Spitz's tumors generating the least consensus. 21 With respect to the latter, Barnhill et al 21 demonstrated a lack of consensus among members of an expert panel for 17 of 30 cases; 13 of 21 lesions held to be Spitz tumors metastasized. Another group showed sentinel lymph node parenchymal metastases in five of 10 patients with Spitzoid lesions.…”

Section: The Nature Of Error In Dermatopathological Practicementioning

confidence: 99%

Medicolegal aspects of neoplastic dermatology

Crowson

2006

Modern Pathology

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Medical malpractice litigation is rising at an explosive rate in the US and, to a lesser extent, in Canada. The impact of medical malpractice litigation on health care costs and the cost of insurance is dramatic. Certain specialist categories are becoming uninsurable in some parts of the US, while in others, clinicians are retiring early, restricting or changing practice or changing states of residence in consequence of medical malpractice claims and of the cost and availability of insurance. This, in turn, has had the real effect of denying care to patients in some communities in the US. Some 13% of all medical malpractice claims relate to one area of neoplastic dermatopathology, specifically, melanocytic neoplasia. Certain steps can be taken by pathology laboratories to reduce, but never completely eliminate, the risk of medical malpractice claims. In this review, attention is paid to the source of medical malpractice claims and an abbreviated approach to specific strategies for risk management is presented.

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“…1 However, a complete agreement for difficult melanocytic neoplasms was observed only in 54.5% and a high level of disagreement (ie, benign vs malignant) was found in 25% of cases among consultant pathologists. [1][2][3][4][5] Such ambiguous melanocytic tumors are divided into thin and thick tumors. 4 Thin ambiguous melanocytic lesions are frequently encountered as dysplastic nevus or atypical intraepidermal melanocytic proliferation, thus raising the diagnostic issue of atypical nevus or truly superficial spreading thin or in situ melanoma.…”

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confidence: 99%

Fluorescence in situ hybridization, a diagnostic aid in ambiguous melanocytic tumors: European study of 113 cases

et al. 2011

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Some melanocytic tumors are ambiguous, so the reproducible histopathological diagnosis of benign or malignant lesion is difficult. This study evaluated the contribution of fluorescence in situ hybridization (FISH) first in 43 non-equivocal melanomas and nevi, and then in 113 ambiguous melanocytic tumors selected by expert pathologists from six different European institutions. We included two groups of ambiguous tumors: patients without recurrence (5-year minimal follow-up) and with metastases. An independent triple-blind histopathological review was performed to classify tumors as 'favor benign' (AÀ) or 'favor malignant' (A þ ). A four-color probe set targeting 6p25, 6q23, 11q13 and CEP6 was used for FISH. In the 43 non-equivocal melanomas and nevi, sensitivity was 85% and specificity 90%. Ninety out of 95 ambiguous melanocytic tumors included were FISH interpretable (67 FISH negative and 23 FISH positive). Of the 90 patients, 69 presented no recurrence and 21/90 exhibited metastases. These ambiguous tumors were mostly spitzoid tumors (45/90). Histopathological reviewers classified these tumors as favor malignant (49/90) and favor benign (32/90), whereas nine cases had a discordant diagnosis. By comparison with outcome, the sensitivity and specificity of histopathological review were 95 and 52%, and the sensitivity and specificity of FISH were 43 and 80%. Compared with histopathological review, the sensitivity and specificity of FISH were 34.5 and 91%. Interestingly, by combining the histopathological diagnosis with FISH results, the diagnosis was optimized, especially by increasing specificity (76% instead of 52% for expert diagnosis alone) and by improving sensitivity compared with FISH alone (90 vs 43% for FISH result alone). The value of this FISH test is to add a reproducible demonstration of malignancy to the histopathological diagnosis, especially in doubtful/ambiguous melanocytic tumors. A positive FISH test reinforces the diagnosis of melanoma, allowing such tumors (particularly thick tumors) to be managed as melanomas.

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Atypical spitz nevi/tumors: Lack of consensus for diagnosis, discrimination from melanoma, and prediction of outcome

Cited by 403 publications

References 23 publications

TRPM1 (Melastatin-1/MLSN1) mRNA expression in Spitz nevi and nodular melanomas

TRPM1 (Melastatin-1/MLSN1) mRNA expression in Spitz nevi and nodular melanomas

Medicolegal aspects of neoplastic dermatology

Fluorescence in situ hybridization, a diagnostic aid in ambiguous melanocytic tumors: European study of 113 cases

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