Spitz nevus versus spitzoid malignant melanoma: An evaluation of the current distinguishing histopathologic criteria

Walsh, Noreen; Crotty, Kerry A.; Palmer, A. W.; McCarthy, Stanley W.

doi:10.1016/s0046-8177(98)90421-x

Cited by 116 publications

(78 citation statements)

References 16 publications

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“…20,27,33,56 The term probably best describes a rare group of tumors often developing in young individuals who are only diagnosed as melanoma in retrospect, that is, after the development of metastases and an aggressive course. Given the profound difficulty of distinguishing some Spitz tumors from melanoma, the author discourages the use of term Spitzoid melanoma since it may result in the indiscriminate labeling of a heterogeneous group of lesions including benign Spitz tumors, lesions that are biologically indeterminant, conventional melanomas, and also the rare controversial group of tumors mentioned above: 'metastasizing Spitz tumor'.…”

Section: Spitzoid Melanomamentioning

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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Section: Spitzoid Melanomamentioning

confidence: 99%

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

2006

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“…The female to male ratio was 1:7. The anatomic location of the tumors was: upper extremity (1); lower extremity (4); head and neck (7); and trunk (6).…”

Section: Demographic Datamentioning

confidence: 99%

“…3,4 Some studies have suggested the following histologic criteria for assessing the malignant potential of Spitz nevi: large size (41.0 cm), tumor extension into the subcutis, presence of ulceration, and high mitotic index. 5,6 However, these studies focused mainly on the clinical and histologic features without consideration of the immunohistochemical profile.…”

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confidence: 99%

Spitz nevi and atypical Spitz nevi/tumors: a histologic and immunohistochemical analysis

et al. 2005

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A subset of Spitz nevi poses substantial diagnostic difficulty, even among experts, due to its resemblance to malignant melanoma. These lesions are termed atypical Spitz nevi/tumors and there is currently a lack of objective criteria for predicting their biologic behavior. We compared the expression of Ki-67, p21, and fatty acid synthase by immunohistochemistry in 10 atypical Spitz nevi, 28 typical Spitz nevi, 19 compound melanocytic nevi and 18 invasive malignant melanomas. There was a progressive increase in fatty acid synthase cytoplasmic expression with statistically significant differences observed between Spitz nevi and atypical Spitz nevi (P ¼ 0.003) and between atypical Spitz nevi and malignant melanoma (Po0.050). Ki-67 nuclear staining was lower in both typical and atypical forms of Spitz lesions than in malignant melanoma (Po0.001). The degree of P21 nuclear expression in atypical Spitz nevi was not significantly different than in Spitz nevi, but was significantly greater than expression in conventional nevi and approached significance after multiple comparisons corrections for malignant melanoma. Thus, a high level of P21 expression makes a tumor more likely to be a typical or atypical Spitz nevus than a malignant melanoma, especially when coupled with a low Ki-67 index and weak expression of fatty acid synthase. These immunohistochemical observations support the concept that atypical Spitz nevi are distinct lesions of borderline biologic behavior residing between Spitz nevi and malignant melanoma. The study also compared a large array of histologic features of 16 cases of typical Spitz nevi in children with 12 typical Spitz nevi in adults. The adult lesions were significantly more likely to be intradermal and to display dermal fibroplasia, but were histologically similar to their pediatric counterparts in all other respects.

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“…10,13,16,21,22,48 Although the 13 spitzoid melanomas maintained some low-power resemblance to Spitz nevi, they demonstrated at least one, and often multiple, of the following histologic features: asymmetrical growth, lack of lateral circumscription, pagetoid spread of melanocytes in the epidermis, aberrant dermal growth, dermal mitoses at all levels of the lesion, atypical mitoses, and high-grade nuclear atypia. 9,10,12,13,48 The Institutional Review Board at the University of Michigan has approved this study.…”

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.…”

mentioning

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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Spitz nevus versus spitzoid malignant melanoma: An evaluation of the current distinguishing histopathologic criteria

Cited by 116 publications

References 16 publications

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

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

Spitz nevi and atypical Spitz nevi/tumors: a histologic and immunohistochemical analysis

BRAF and NRAS mutations in spitzoid melanocytic lesions

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