Spindle Cell and Epithelioid Cell Nevi with Atypia and Metastasis (Malignant Spitz Nevus)

Smith, Kathleen J.; Barrett, Terry L.; Skelton, Henry G.; Lupton, George P.; Graham, James H.

doi:10.1097/00000478-198911000-00003

Cited by 220 publications

(141 citation statements)

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“…The latter two tumors also potentially could be described as 'metastasizing Spitz tumors'. In general, all 12 tumors were characterized by many of the same features as reported by Smith et al, 31 that is, large size, ulceration, significant depth, prominent cellular density, lack of maturation, a pushing border, Figure 2 Compound Spitz tumor with atypical features of a 36-year-old woman with lesion from the right thigh. The tumor measures less than 10 mm in diameter and at least 2.1 mm in Breslow thickness.…”

Section: Background Of the Atypical Spitz Tumorsupporting

confidence: 56%

“…In a subsequent report of 32 cases, Smith et al 31 introduced the term 'spindle and epithelioid cell nevus with atypia and metastasis (malignant Spitz nevus)' (see below) to describe a series of Spitz-like melanocytic tumors characterized by large size (41 cm), frequent ulceration, deep extension into subcutaneous fat with bulbous 'pushing' margins, prominent cellular density, lack of maturation, cytological atypia greater than that expected for a 'Spitz nevus' (large and pleomorphic cells, prominent nucleoli), significant numbers of mitoses (up to 5 in a single high-power field), and focal necrosis. These tumors developed in relatively young individuals (41% o14 years and 82% o29 years of age), and virtually all were located on the head and neck, and extremities (71%).…”

Section: Background Of the Atypical Spitz Tumormentioning

confidence: 91%

“…Size beyond 10 mm is generally considered abnormal. [29][30][31] This is a continuous variable and there are obviously exceptions to this criterion.…”

Section: Histopathologymentioning

confidence: 99%

“…These findings may have relevance to the entity of the so-called 'metastasizing Spitz tumor' as some of these patients have remained disease-free with long-term follow-up of up to 15 years or more. 29,31 Among the limited number of cases studied thus far by SLN biopsy, such Spitzoid tumors have not necessarily had the degree of abnormality, that is, size 41 cm, ulceration, involvement of subcutaneous fat, high mitotic rate, as such tumors resulting in macroscopic metastases. 51 …”

Section: Sentinel Lymph Node Biopsymentioning

confidence: 99%

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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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Section: Background Of the Atypical Spitz Tumorsupporting

confidence: 56%

Section: Background Of the Atypical Spitz Tumormentioning

confidence: 91%

“…Size beyond 10 mm is generally considered abnormal. [29][30][31] This is a continuous variable and there are obviously exceptions to this criterion.…”

Section: Histopathologymentioning

confidence: 99%

Section: Sentinel Lymph Node Biopsymentioning

confidence: 99%

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

2006

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“…A melanoma of a few millimeters in diameter, if in vertical growth phase, may kill. 14 Third, the distinction between melanoma and nevus can be challenging at the light microscopic, and even at the molecular level 15,16 just as it is at the clinical level. 17,18 Various studies have shown that even expert melanocytic lesion pathologists are unable to obtain a concordant view on one-quarter to two-thirds of studied 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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