Nevus of Large Spindle and/or Epithelioid Cells (Spitz's Nevus)

Paniago‐Pereira, Cleire

doi:10.1001/archderm.1978.01640240053018

Cited by 212 publications

(103 citation statements)

References 36 publications

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“…The second group consisted of 10 'typical' Spitz nevus specimens obtained from children age Յ 10 years; the diagnostic criteria for these tumors have been described previously. 17,18 …”

Section: Selection Of Specimensmentioning

confidence: 99%

Genetic similarities between Spitz nevus and Spitzoid melanoma in children

Gill

Cohen

Renwick

et al. 2004

Cancer

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BACKGROUNDMelanoma in children is rare. Diagnosis of the subtype of melanoma known as Spitzoid melanoma can be extremely challenging in this age group. Spitzoid melanoma clinically and histopathologically resembles a benign melanocytic proliferation referred to as Spitz nevus. In some cases, distinction between the two is impossible. Initial misdiagnoses of Spitzoid melanomas as Spitz nevi, thus leading to fatal outcomes, have occurred. The genetic basis and biologic behavior of Spitzoid melanoma is unknown. Although melanoma specimens exhibit high rates of mutation in the B‐RAF and N‐RAS genes, the Spitzoid melanoma subtype has not been evaluated. Spitz nevi have been found to be associated with a low percentage of mutations in the H‐RAS gene; however, the mutational profile of H‐RAS in Spitzoid melanoma is unknown.METHODSThe authors evaluated a unique series of melanomas occurring in prepubescent children that showed Spitz nevus–like histopathology (Spitzoid melanoma). All of the melanomas in the current series have metastasized to lymph nodes, confirming the diagnosis of melanoma. The authors examined these tumors, as well as age‐matched Spitz nevi, for mutations in the B‐RAF, N‐RAS, and H‐RAS genes.RESULTSActivating hotspot mutations in the B‐RAF, N‐RAS, and H‐RAS genes were not identified in Spitzoid melanoma or Spitz nevus specimens.CONCLUSIONSThere are genetic similarities with respect to the B‐RAF, N‐RAS, and H‐RAS genes between Spitzoid melanoma and Spitz nevi. Such similarities further differentiate these two tumor types from other melanoma subtypes and from melanocytic nevi, respectively. However, mutation analysis of B‐RAF, N‐RAS, and H‐RAS was not useful in differentiating between Spitzoid melanoma and Spitz nevus in children. Cancer 2004. © 2004 American Cancer Society.

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“…The second group consisted of 10 'typical' Spitz nevus specimens obtained from children age Յ 10 years; the diagnostic criteria for these tumors have been described previously. 17,18 …”

Section: Selection Of Specimensmentioning

confidence: 99%

Genetic similarities between Spitz nevus and Spitzoid melanoma in children

Gill

Cohen

Renwick

et al. 2004

Cancer

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“…As we have described various authors have reviewed their own series of 'Spitz nevi' and accordingly formulated their 'criteria' from these self-selected (and consequently biased) series of lesions (Table 2). 7,11,12,26 The inherent flaws resulting from this exercise involve circular reasoning, the cases in general have not been population-based, the number of cases has often not been adequate, and the cases have not had long-term follow-up (of 8-10 years) to know the outcomes. 22,25,26 Following up on the observations that the vast majority of these Spitzoid lesions do not seem to recur or to metastasize, they have been lumped as a group in benign melanocytic nevi, even though some proportion of lesions seem impossible to distinguish from melanoma and uncommon or rare lesions behave aggressively.…”

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confidence: 99%

The Spitzoid lesion: rethinking Spitz tumors, atypical variants, ‘Spitzoid melanoma' and risk assessment

2006

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Although much remains to be learned about Spitzoid lesions, there is increasing evidence that these tumors may be a type of melanocytic neoplasm distinct from conventional melanocytic nevi and malignant melanoma. In the current communication, the author has attempted to describe accurately the state-of-the-art surrounding these lesions, their nomenclature, and assessment of risk. Acknowledging the peculiar nature of Spitzoid lesions, the author prefers the term Spitz tumor rather than 'Spitz nevus' (except perhaps for the most typical lesions) and argues against using the term 'Spitzoid melanoma' until more information is available to justify such a term. The author also believes that patients are best served by the comprehensive evaluation of Spitzoid lesions and their classification into three categories: (1) Spitz tumor without significant abnormality, (2) Spitz tumor with one or more atypical features (atypical Spitz tumor), including those judged to have indeterminate biological potential, and (3) malignant melanoma, rather than the two categories of 'Spitz nevus' and melanoma. Only rigorous characterization of sufficient numbers of Spitzoid lesions and long-term follow-up of patients will provide truly objective information for the formulation of optimal guidelines for the management of patients with these lesions.

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“…The spitzoid lesions were independently reviewed by three board certified dermatopathologists (LL, LDS, and DRF) with diagnostic expertise in pigmented lesions and who are members of the Multidisciplinary Melanoma Clinic at the University of Michigan. Of the 48 Spitz nevi, 21 were classic Spitz nevi, on the basis of previously published criteria, 6,7 and two were desmoplastic Spitz nevi. The remaining 25 Spitz nevi demonstrated some atypical features, such as architectural disorder, increased cytologic atypia and/or inflammation.…”

Section: Case Selectionmentioning

confidence: 99%

“…3,4 Fortunately, most spitzoid lesions can be classified into benign Spitz nevi or Spitz-like melanomas based on published criteria. [5][6][7][8][9][10][11][12][13][14][15] However, a subset of spitzoid lesions remain that have histologic features that deviate from a typical Spitz nevus, yet are insufficient for a definitive diagnosis of Spitzlike melanoma. These atypical spitzoid lesions have been referred to variously in the literature as borderline and intermediate melanocytic neoplasia, minimal-deviation melanoma, nevoid melanoma, atypical Spitz nevus/tumor, malignant Spitz nevus, problematic Spitzoid melanocytic lesions, and diagnostically controversial Spitzoid melanocytic tumors.…”

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confidence: 99%

BRAF and NRAS mutations in spitzoid melanocytic lesions

et al. 2006

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BRAF mutations are common events in a variety of melanocytic nevi and primary cutaneous melanomas. We have previously found BRAF mutations in 82% of nevi, consisting of congenital, common acquired and dysplastic types, and 33% of primary cutaneous melanomas other than the spitzoid type, similar to other published reports. A small number of studies have evaluated Spitz nevi and have failed to detect any lesions possessing a BRAF mutation. Only one study included categories of atypical Spitz nevus and borderline lesions suspected to be spitzoid melanomas, along with classic Spitz nevi and spitzoid melanomas. We examined a spectrum of spitzoid lesions that included 48 Spitz nevi, some with atypical features, seven atypical (borderline) Spitz tumors, and 13 spitzoid melanomas. BRAF mutations were detected in 12 of 68 spitzoid lesions, of which two were spitzoid melanomas and 10 were Spitz nevi. Five of the 10 Spitz nevi with BRAF mutations were altered by more than usual cytologic atypia and/or architectural atypia overlapping with dysplastic nevi, or irritation/inflammation; one desmoplastic Spitz nevus had a BRAF mutation. These results indicate that a small subset of Spitz nevi, some with atypical histologic features, possess BRAF mutations. Therefore, the BRAF mutational status does not separate all Spitz nevi from spitzoid melanomas and non-Spitz types of melanocytic proliferations, contrary to previous reports.

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Nevus of Large Spindle and/or Epithelioid Cells (Spitz's Nevus)

Cited by 212 publications

References 36 publications

Genetic similarities between Spitz nevus and Spitzoid melanoma in children

Genetic similarities between Spitz nevus and Spitzoid melanoma in children

The Spitzoid lesion: rethinking Spitz tumors, atypical variants, ‘Spitzoid melanoma' and risk assessment

BRAF and NRAS mutations in spitzoid melanocytic lesions

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