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Cloutier JM, Wang M, Vemula SS, Mirza S, Weier J, Aquino JD, McCalmont TH, LeBoit PE, Bastian BC, Yeh I. Amplification of Mutant NRAS in Melanocytic Tumors With Features of Spitz Tumors. Mod Pathol 2024; 37:100469. [PMID: 38467248 DOI: 10.1016/j.modpat.2024.100469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/13/2024] [Accepted: 03/04/2024] [Indexed: 03/13/2024]
Abstract
NRAS activating mutations are prevalent in melanocytic neoplasia, occurring in a subset of common acquired melanocytic nevi and ∼30% of cutaneous melanomas. In this study, we described a cohort of 7 distinctive melanocytic tumors characterized by activating point mutations in codon 61 of NRAS with amplification of the mutant NRAS allele and shared clinicopathologic features. These tumors occurred predominantly in younger patients, with a median age of 20 years (range, 6-56 years). They presented as papules on the helix of the ear (4 cases) or extremities (3 cases). Microscopically, the tumors were cellular, relatively well-circumscribed, compound, or intradermal proliferations. The tumor cells often extended into the deep reticular dermis and involved the superficial subcutaneous fat in some cases. The melanocytes were epithelioid to spindled with moderate amounts of cytoplasm and conspicuous nucleoli. They were arranged in short plexiform fascicles, nests, and cords. Some cases had occasional pleomorphic and multinucleated melanocytes. Rare dermal mitotic figures were present in all cases. The dermis contained thick collagen bundles and minimal solar elastosis. Follow-up data were available for 5 patients, with a median period of 4.2 years (range, 1-9 years), during which no recurrences or metastases were reported. Our series highlights a clinicopathologically and molecularly distinctive subset of NRAS-mutated tumors with amplification of the mutant NRAS allele.
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Affiliation(s)
- Jeffrey M Cloutier
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
| | - Meng Wang
- Department of Dermatology, University of California, San Francisco, California
| | - Swapna S Vemula
- Department of Dermatology, University of California, San Francisco, California
| | - Sonia Mirza
- Department of Dermatology, University of California, San Francisco, California
| | - Jingly Weier
- Department of Dermatology, University of California, San Francisco, California
| | - Jamie D Aquino
- Department of Pathology, University of California, San Francisco, California
| | - Timothy H McCalmont
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California; Golden State Dermatology Associates, Walnut Creek, California
| | - Philip E LeBoit
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California; Helen Diller Family Cancer Center, University of California, San Francisco, California
| | - Boris C Bastian
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California; Helen Diller Family Cancer Center, University of California, San Francisco, California
| | - Iwei Yeh
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California; Helen Diller Family Cancer Center, University of California, San Francisco, California.
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Cesinaro AM, Gallo G, Manfredini S, Maiorana A, Bettelli SR. ROS-1 Pattern Of Immunostaining In 11 Cases Of Spitzoid Tumours: Comparison With Histopathological, Fish And Ngs Analysis. Histopathology 2021; 79:966-974. [PMID: 34231248 DOI: 10.1111/his.14445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 12/17/2022]
Abstract
AIMS Spitzoid tumours have been shown to harbour exclusive kinase fusions. Few studies have analysed substantial numbers of ROS-1 rearranged lesions, particularly immunohistochemistry has been poorly investigated. METHODS AND RESULTS Among a group of 35 spitzoid tumours, of which 34 consecutively diagnosed in a 3-year period, we found 11 cases ROS-1 positive at immunohistochemistry, belonging to 10 patients, 8 females and 2 males, aged 3 to 52 years (median 29); most lesions (8) were localized on the lower extremities. Four patterns of immunostaining were observed: cytoplasmic granular diffuse (6 cases), sparse cytoplasmic granules (3), paranuclear dots (1), and nuclear (1). All cases resulted rearranged at FISH analysis (cut-off >15%). NGS-RNA analysis featured specific fusions of ROS-1 in 4 cases: two with PWWP2A, one with PPFIBP1, and one with ZCCHC8. NGS-DNA analysis demonstrated in 5 cases specific mutations of AKT, EGFR, NRAS, MYC, ALK, and KIT genes. ROS-1 lesions belonged predominantly to the "Atypical Spitz Tumour" group and featured mainly a nested pattern at histology. Interestingly, one patient developed two lesions ROS-1 positive. CONCLUSIONS Immunohistochemistry showed a 100% of sensitivity and specificity compared to FISH results, corresponding to ROS-1 rearrangement in 31% of cases studied. These observations shed new light on the value of immunohistochemical evaluation of ROS-1 in spitzoid tumours. ROS-1 patterns of immunostaining probably reflect different subcellular localizations of ROS-1 fusions, although no specific correlations were found in cases studied. Immunohistochemistry and FISH resulted the most sensitive techniques in detecting ROS-1 rearrangement in this subset of neoplasms.
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Affiliation(s)
| | - Graziana Gallo
- Struttura Complessa di Anatomia - Istologia e Citologia Patologica e Struttura Semplice Dipartimentale di Patologia Molecolare e Medicina Predittiva
| | | | - Antonino Maiorana
- Struttura Complessa di Anatomia - Istologia e Citologia Patologica e Struttura Semplice Dipartimentale di Patologia Molecolare e Medicina Predittiva
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Raghavan SS, Peternel S, Mully TW, North JP, Pincus LB, LeBoit PE, McCalmont TH, Bastian BC, Yeh I. Spitz melanoma is a distinct subset of spitzoid melanoma. Mod Pathol 2020; 33:1122-1134. [PMID: 31900433 PMCID: PMC7286778 DOI: 10.1038/s41379-019-0445-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/28/2019] [Indexed: 01/20/2023]
Abstract
Melanomas that have histopathologic features that overlap with those of Spitz nevus are referred to as spitzoid melanomas. However, the diagnostic concept is used inconsistently and genomic analyses suggest it is a heterogeneous category. Spitz tumors, the spectrum of melanocytic neoplasms extending from Spitz nevi to their malignant counterpart Spitz melanoma, are defined in the 2018 WHO classification of skin tumors by the presence of specific genetic alterations, such as kinase fusions or HRAS mutations. It is unclear what fraction of "spitzoid melanomas" defined solely by their histopathologic features belong to the category of Spitz melanoma or to other melanoma subtypes. We assembled a cohort of 25 spitzoid melanomas diagnosed at a single institution over an 8-year period and performed high-coverage DNA sequencing of 480 cancer related genes. Transcriptome wide RNA sequencing was performed for select cases. Only nine cases (36%) had genetic alterations characteristic of Spitz melanoma, including HRAS mutation or fusion involving BRAF, ALK, NTRK1, or MAP3K8. The remaining cases were divided into those with an MAPK activating mutation and those without an MAPK activating mutation. Both Spitz melanoma and spitzoid melanomas in which an MAPK-activating mutation could not be identified tended to occur in younger patients on skin with little solar elastosis, infrequently harbored TERT promoter mutations, and had a lower burden of pathogenic mutations than spitzoid melanomas with non-Spitz MAPK-activating mutations. The MAPK-activating mutations identified affected non-V600 residues of BRAF as well as NRAS, MAP2K1/2, NF1, and KIT, while BRAF V600 mutations, the most common mutations in melanomas of the WHO low-CSD category, were entirely absent. While the "spitzoid melanomas" comprising our cohort were enriched for bona fide Spitz melanomas, the majority of melanomas fell outside of the genetically defined category of Spitz melanomas, indicating that histomorphology is an unreliable predictor of Spitz lineage.
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Affiliation(s)
| | - Sandra Peternel
- Departments of Pathology and Dermatology, University of California San Francisco, San Francisco, CA, USA
- Department of Dermatovenerology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Thaddeus W Mully
- Departments of Pathology and Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey P North
- Departments of Pathology and Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Laura B Pincus
- Departments of Pathology and Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Philip E LeBoit
- Departments of Pathology and Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Timothy H McCalmont
- Departments of Pathology and Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Boris C Bastian
- Departments of Pathology and Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Iwei Yeh
- Departments of Pathology and Dermatology, University of California San Francisco, San Francisco, CA, USA.
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Yuen J, AlZahrani F, Horne G, Naert K, McCalmont T, Unger K, Fiorillo L. Invasive melanoma in a 5-year-old Canadian patient: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19829630. [PMID: 30815261 PMCID: PMC6381421 DOI: 10.1177/2050313x19829630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Atypical Spitzoid lesions pose a distinct challenge in classification as they may comprise a mixture of both classic benign nevus and cutaneous melanoma characteristics. Immunostaining and molecular analysis, such as comparative genomic hybridization, can assist in narrowing the differential diagnosis. We present a case of a 5-year-old male with an atypical Spitzoid lesion on his back. Initial histopathology revealed a relatively symmetric lesion with mitotic figures and poor maturation of melanocytes with descent into the dermis. Immunohistochemistry demonstrated a loss of p16, and array comparative genomic hybridization revealed a loss of chromosome 9, supporting a diagnosis of invasive melanoma arising in conjunction with a remnant of a conventional melanocytic nevus. This case is the first in Canada to demonstrate the use of array comparative genomic hybridization for diagnosing melanoma in a young paediatric patient.
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Affiliation(s)
- Joanna Yuen
- Division of Dermatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Fatmah AlZahrani
- Division of Dermatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Garnet Horne
- Department of Pathology and Laboratory Medicine, Red Deer Regional Hospital, Red Deer, AB, Canada
| | - Karen Naert
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Timothy McCalmont
- Department of Pathology and Dermatology, University of California San Francisco, San Francisco, CA, USA.,USF Dermatopathology and Oral Pathology Service, University of California San Francisco, San Francisco, CA, USA
| | - Kathy Unger
- Family Medical Associates, Lacombe, AB, Canada
| | - Loretta Fiorillo
- Division of Dermatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Division of Pediatric Dermatology, University of Alberta, Edmonton, AB, Canada.,Dermatology Residency Training Program, University of Alberta, Edmonton, AB, Canada
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Jacquemus J, Perron E, Pissaloux D, Alberti L, de la Fouchardière A. Atypical cutaneous melanocytic tumours arising in two patients with Li-Fraumeni syndrome. Pathology 2017; 49:801-805. [PMID: 29108654 DOI: 10.1016/j.pathol.2017.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/24/2017] [Accepted: 08/02/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - Emilie Perron
- Département of Biopathology, Centre Leon Bérard, Lyon, France; Service d'anatomopathologie, Centre Hospitalier Universitaire de Québec-Université Laval, Canada; Département de Biologie Moléculaire, de Biochimie Médicale et de Pathologie, Faculté de Médecine, Université Laval, Québec, Canada
| | | | - Laurent Alberti
- Département of Biopathology, Centre Leon Bérard, Lyon, France
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Hélias-Rodzewicz Z, Funck-Brentano E, Terrones N, Beauchet A, Zimmermann U, Marin C, Saiag P, Emile JF. Variation of mutant allele frequency in NRAS Q61 mutated melanomas. BMC DERMATOLOGY 2017; 17:9. [PMID: 28668077 PMCID: PMC5494128 DOI: 10.1186/s12895-017-0061-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/21/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Somatic mutations of BRAF or NRAS activating the MAP kinase cell signaling pathway are present in 70% of cutaneous melanomas. The mutant allele frequency of BRAF V600E (M%BRAF) was recently shown to be highly heterogeneous in melanomas. The present study focuses on the NRAS Q61 mutant allele frequency (M%NRAS). METHODS Retrospective quantitative analyze of 104 NRAS mutated melanomas was performed using pyrosequencing. Mechanisms of M%NRAS imbalance were studied by fluorescence in situ hybridization (FISH) and microsatellite analysis. RESULTS M%NRAS was increased in 27.9% of cases. FISH revealed that chromosome 1 instability was the predominant mechanism of M%NRAS increase, with chromosome 1 polysomy observed in 28.6% of cases and intra-tumor cellular heterogeneity with copy number variations of chromosome 1/NRAS in 23.8%. Acquired copy-neutral loss of heterozygosity (LOH) was less frequent (19%). However, most samples with high M%NRAS had only one copy of NRAS locus surrounding regions suggesting a WT allele loss. Clinical characteristics and survival of patients with either <60% or ≥60% of M%NRAS were not different. CONCLUSION As recently shown for M%BRAF, M%NRAS is highly heterogeneous. The clinical impacts of high M%NRAS should be investigated in a larger series of patients.
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Affiliation(s)
- Zofia Hélias-Rodzewicz
- Research Unit EA4340 Biomarkers in Cancerology and Hemato Oncology, Versailles SQY University, Paris-Saclay University, 9, Avenue Charles de Gaulle, 92104 Boulogne-Billancourt, France
- Department of Pathology, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
| | - Elisa Funck-Brentano
- Research Unit EA4340 Biomarkers in Cancerology and Hemato Oncology, Versailles SQY University, Paris-Saclay University, 9, Avenue Charles de Gaulle, 92104 Boulogne-Billancourt, France
- Department of Dermatology, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
| | - Nathalie Terrones
- Research Unit EA4340 Biomarkers in Cancerology and Hemato Oncology, Versailles SQY University, Paris-Saclay University, 9, Avenue Charles de Gaulle, 92104 Boulogne-Billancourt, France
| | - Alain Beauchet
- Department of Public Health, Ambroise Paré Hospital Ap-HP, Boulogne-Billancourt, France
| | - Ute Zimmermann
- Research Unit EA4340 Biomarkers in Cancerology and Hemato Oncology, Versailles SQY University, Paris-Saclay University, 9, Avenue Charles de Gaulle, 92104 Boulogne-Billancourt, France
- Department of Pathology, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
| | - Cristi Marin
- Research Unit EA4340 Biomarkers in Cancerology and Hemato Oncology, Versailles SQY University, Paris-Saclay University, 9, Avenue Charles de Gaulle, 92104 Boulogne-Billancourt, France
- Department of Pathology, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
| | - Philippe Saiag
- Research Unit EA4340 Biomarkers in Cancerology and Hemato Oncology, Versailles SQY University, Paris-Saclay University, 9, Avenue Charles de Gaulle, 92104 Boulogne-Billancourt, France
- Department of Dermatology, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
| | - Jean-François Emile
- Research Unit EA4340 Biomarkers in Cancerology and Hemato Oncology, Versailles SQY University, Paris-Saclay University, 9, Avenue Charles de Gaulle, 92104 Boulogne-Billancourt, France
- Department of Pathology, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
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Uguen A, Uguen M, Talagas M, Gobin E, Marcorelles P, De Braekeleer M. Fluorescence in situ hybridization testing of chromosomes 6, 8, 9 and 11 in melanocytic tumors is difficult to automate and reveals tumor heterogeneity in melanomas. Oncol Lett 2016; 12:2734-2741. [PMID: 27698849 PMCID: PMC5038458 DOI: 10.3892/ol.2016.4949] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 06/16/2016] [Indexed: 01/12/2023] Open
Abstract
Malignant melanomas may be difficult to differentiate from benign nevi on the basis of histology. Contrary to nevi, the majority of melanomas harbor chromosomal imbalances. Comparative genomic hybridization-based and fluorescence in situ hybridization (FISH) tests can help differentiating malignant from benign tumors. In the present study, eight-bacterial artificial chromosome (BAC) probes targeting chromosomes 6, 8, 9 and 11 were tested by FISH, and compared with a commercial four-color FISH probe set targeting chromosomes 6 and 11 in a first set of 62 tissue microarray-included melanocytic tumors (47 melanomas and 15 nevi). A second set of 108 tumors (70 melanomas and 38 nevi) was analyzed with the eight-probes kit, and manual counting was compared with the newly developed automated FISH signals counting and with semi-quantitative visual detection of chromosomal imbalances. Intra-tumor heterogeneity was also evaluated in 12 melanomas and 10 patients with paired melanoma samples. Testing the tumors from the first set with the commercial kit and the eight-probes test permitted to correctly identify 45/47 and 47/47 melanomas, respectively. In the second tumor set, 65/70 malignant tumors presented at least one chromosomal imbalance, whereas none was detected in the nevi. The agreement between manual and automated signals counting was better in good-quality FISH slides compared with poor-quality slides. Semi-quantitative visual appreciation of chromosomal imbalances also reached strong agreement with exact manual counting. In addition, a frequent cytogenetic heterogeneity within melanomas and between paired tumors was noticed in patients with metastatic melanomas. To conclude, FISH testing targeting chromosomes 6, 8, 9 and 11 enabled to differentiate the majority of melanomas from nevi but was difficult to automate. Tumor cytogenetic heterogeneity was frequent and could impair FISH testing.
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Affiliation(s)
- Arnaud Uguen
- Inserm, U1078, F-29609 Brest, France; Department of Pathology, Brest University Hospital, F-29220 Brest, France; European University of Brittany, F-29220 Brest, France
| | - Marie Uguen
- Department of Pathology, Brest University Hospital, F-29220 Brest, France
| | - Matthieu Talagas
- Department of Pathology, Brest University Hospital, F-29220 Brest, France; European University of Brittany, F-29220 Brest, France; EA4685, Brest Medical School, F-29220 Brest, France
| | - Eric Gobin
- Department of Pathology, Brest University Hospital, F-29220 Brest, France
| | - Pascale Marcorelles
- Department of Pathology, Brest University Hospital, F-29220 Brest, France; European University of Brittany, F-29220 Brest, France; EA4685, Brest Medical School, F-29220 Brest, France
| | - Marc De Braekeleer
- Inserm, U1078, F-29609 Brest, France; European University of Brittany, F-29220 Brest, France; Department of Cytogenetics and Reproduction Biology, Brest University Hospital, F-29220 Brest, France
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Massi D, De Giorgi V, Mandalà M. The complex management of atypical Spitz tumours. Pathology 2016; 48:132-41. [PMID: 27020385 DOI: 10.1016/j.pathol.2015.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 12/12/2022]
Abstract
In recent years, advances in molecular genetic characterisation have revealed that atypical Spitz tumours (ASTs) are basically heterogeneous diseases, although the clinical relevance of these findings is yet to be determined. Evidence of molecularly-defined diverse groups of lesions continues to accumulate; however, conflicting, confusing, and overlapping terminology has fostered ambiguity and lack of clarity in the field in general. The lack of fundamental diagnostic (morphological) unambiguous classification framework results in a number of challenges in the interpretation of the molecular genetic data. In this review, we discuss the main difficulties for pathologists and clinicians in the complex management of ASTs, with particular emphasis on the different genetic and biological features of recently-described entities, and offer our view of what could be medically reasonable to guide a rational approach in light of current data.
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Affiliation(s)
- Daniela Massi
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Italy.
| | | | - Mario Mandalà
- Unit of Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Harms KL, Lowe L, Fullen DR, Harms PW. Atypical Spitz Tumors: A Diagnostic Challenge. Arch Pathol Lab Med 2016; 139:1263-70. [PMID: 26414472 DOI: 10.5858/arpa.2015-0207-ra] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Spitzoid melanocytic lesions encompass a spectrum from benign Spitz nevi to malignant spitzoid melanomas. Spitzoid melanocytic neoplasms have significant morphologic and molecular differences from conventional melanocytic lesions, and prediction of biologic behavior and metastatic risk may be difficult. Most challenging is the atypical Spitz tumor, a borderline spitzoid melanocytic lesion of uncertain malignant potential that has overlapping histologic features with conventional Spitz nevus and spitzoid melanoma. Atypical Spitz tumors involve the sentinel lymph nodes at a greater frequency than conventional melanoma and frequently harbor chromosomal copy number changes, yet most cases follow an indolent course. Herein we review the clinical, microscopic, and molecular features of atypical Spitz tumors, including recent molecular advances, including the potential prognostic significance of chromosomal abnormalities, such as homozygous CDKN2A loss.
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Affiliation(s)
- Kelly L Harms
- From the Department of Dermatology (Drs K. L. Harms, Lowe, Fullen, and P. W. Harms), the Comprehensive Cancer Center (Dr K. L. Harms), and the Department of Dermatology and Pathology (Drs Lowe, Fullen, and P. W. Harms), University of Michigan Medical School, Ann Arbor
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