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Zhao G, Lee KC, Peacock S, Reisch LM, Knezevich SR, Elder DE, Piepkorn MW, Elmore JG, Barnhill RL. The utilization of spitz-related nomenclature in the histological interpretation of cutaneous melanocytic lesions by practicing pathologists: results from the M-Path study. J Cutan Pathol 2017; 44:5-14. [PMID: 27686456 PMCID: PMC5177484 DOI: 10.1111/cup.12826] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/27/2016] [Accepted: 09/25/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Spitz nevi, atypical Spitz tumors and spitzoid melanomas ('spitzoid lesions') represent controversial and poorly understood cutaneous melanocytic lesions that are difficult to diagnose histologically. It is unknown how these terms are used by pathologists. METHODS We describe use of Spitz-related terminology using data from the Melanoma Pathology (M-Path) study database comprising pathologists' interpretations of biopsy slides, a nation-wide study evaluating practicing US pathologists' (N = 187) diagnoses of melanocytic lesions (8976 independent diagnostic assessments on 240 total test cases, with 1 slide per case). RESULTS Most pathologists (90%) used the Spitz-related terminology. However, significant variation exists in which specific lesions were diagnosed as spitzoid and in the corresponding treatment recommendations. Recommendations ranged from 'no further treatment' to 'wide excision of 10 mm or greater' with no category capturing more than 50% of responses. For spitzoid melanoma diagnoses, 90% of pathologists recommended excision with ≥10 mm margin. Pathologists report less confidence in diagnosing these lesions compared with other melanocytic proliferations and are more likely to request second opinions and additional clinical information (all p < 0.05). CONCLUSIONS Spitzoid lesions are often not classified in any standardized way, evoke uncertainty in diagnosis by pathologists, and elicit variability in treatment recommendations.
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Affiliation(s)
- Ge Zhao
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA
| | - Kachiu C. Lee
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sue Peacock
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Lisa M. Reisch
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | | | - David E. Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Michael W. Piepkorn
- Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
- Dermatopathology Northwest, Bellevue, WA
| | - Joann G. Elmore
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Raymond L. Barnhill
- Department of Pathology, Institut Curie, and Faculty of Medicine, University of Paris Descartes, Paris, France
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Abstract
Melanoma is uncommon in the pediatric age range, but is increasing in frequency and often presents with atypical features compared to the classic ABCDE criteria common to adult melanoma cases. Moreover, many melanocytic neoplasms in childhood pose diagnostic challenges to the pathologist, and sometimes cannot be unequivocally classified as benign nevi or melanoma. This chapter addresses the evaluation and management of pediatric patients with melanoma and atypical melanocytic neoplasms, including the roles of and unresolved questions surrounding sentinel lymph node biopsy, completion lymphadenectomy, adjuvant therapy, and treatment of advanced disease.
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Affiliation(s)
| | - Jane L Messina
- Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Cutaneous Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
- Department of Pathology and Cell Biology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Dermatology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Damon Reed
- Department of Cutaneous Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Adolescent and Young Adult (AYA) Program, Sarcoma Department, Moffitt Cancer Center, Tampa, FL, USA
- Department of Hematology/Oncology , All Children's Hospital Johns Hopkins Medicine , St. Petersburg, FL, USA
| | - Fariba Navid
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
- Department of Oncologic Sciences and Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
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Affiliation(s)
- Wolter J Mooi
- Department of Pathology 3E43, VU medical centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands, and Department of Pathology, The University of Chicago Hospitals, 5841 South Maryland Avenue, MC 6101 Chicago, IL, USA.
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Affiliation(s)
- Ketty Peris
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy.
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Abstract
In 1999, Spatz et al. reported the first 2 cases of a plexiform variant Spitz nevus. We describe another case of this variant on the upper thigh of a 10-year-old boy and discuss the differential diagnosis. Histologically, it comprised nodules of epithelioid cells with a plexiform arrangement distributed throughout the superficial and deep dermis. The cells had moderate eosinophilic cytoplasm with vesicular nuclei and prominent nucleoli. Intranuclear inclusions were present focally. The tumor nodules were embedded in a myxoid stroma with intratumoral and peritumoral inflammatory cells including both lymphocytes and eosinophils. There were occasional melanin-containing spindle-shaped cells. An intraepidermal component could not be assessed, since the lesion was ulcerated. The differential diagnosis includes both melanocytic and nonmelanocytic lesions exhibiting a plexiform pattern of growth as well as myxoid lesions.
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Affiliation(s)
- B Clarke
- Department of Pathology, Nelson R. Mandela School of Medicine, University of Natal, Private Bag 7, Congella 4013, Durban, South Africa
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Stas M, van den Oord JJ, Garmyn M, Degreef H, De Wever I, De Wolf-Peeters C. Minimal deviation and/or naevoid melanoma: is recognition worthwhile? A clinicopathological study of nine cases. Melanoma Res 2000; 10:371-80. [PMID: 10985672 DOI: 10.1097/00008390-200008000-00009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
One to two per cent of primary cutaneous melanomas share clinical features with benign melanocytic and non-melanocytic skin lesions, and even at histology recognition of their malignant nature is problematic, mainly due to the lack of an intraepithelial component, their nodular aspect and the monotonous cell population throughout the lesion. These tumours were termed minimal deviation melanomas (MDMs) by Reed et al. and later naevoid melanomas by Schmoeckel et al. The name MDM suggests the concept of a more favourable outcome for these melanomas that do not (yet) show the typical features of fully evolved lesions able to metastasize, although naevoid melanomas seem to behave like 'common' melanomas. In a retrospective analysis of nine cases of MDM collected from our database and followed for a median duration of 112 months, we faced similar clinical and histological pitfalls and observed local recurrence following marginal resection. Wide excision, even of local recurrence, and therapeutic node dissection could nevertheless provide survival comparable at least to that predicted by mathematical models for patients who initially had optimal treatment.
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Affiliation(s)
- M Stas
- Department of Surgical Oncology, University Hospitals, Catholic University of Leuven, Belgium.
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Barnhill RL. Malignant melanoma, dysplastic melanocytic nevi, and Spitz tumors. Histologic classification and characteristics. Clin Plast Surg 2000; 27:331-60, viii. [PMID: 10941557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The classification and pertinent histopathologic features of cutaneous melanoma, dysplastic melanocytic nevi, and Spitz tumors are presented. A discussion on melanoma emphasizes an objective approach to classification based on histomorphologic features including location in the skin, disposition and frequency of melanocytes, other specific morphologic features, and cell type. Other topics addressed include common and unusual variants of melanoma, the use of immunohistochemistry, and the histopathologic reporting of melanoma.
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Affiliation(s)
- R L Barnhill
- Pathology Services, Incorporated, Cambridge, Massachusetts, USA
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Affiliation(s)
- M Piepkorn
- Department of Medicine (Dermatology), University of Washington School of Medicine, Seattle 98195
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Abstract
Five cases are described of a distinctive histologic variant of benign spindle and epithelioid cell nevus characterized by extensive and prominent stromal hyalinization. The lesions consisted of a proliferation of spindle or epithelioid nevocytes scattered singly or in small clusters in the dermis and surrounded by abundant paucicellular hyalinized or collagenous stroma. Three patients were men and two were women. Their age range was 23 to 45 years (mean, 32). Two of the lesions were located in the head and neck region, two in the lower extremities, and one in the trunk. Immunohistochemical strains showed positive staining of the spindle or epithelioid cells with S-100 protein and vimentin; stains for keratin, EMA, CEA, actin, and desmin were all negative. Van Gieson and trichrome histochemical reaction demonstrated the collagenous nature of the hyalinized intercellular matrix; Congo red, crystal violet, and alcian blue stains were all negative. The etiology and pathogenesis of the intercellular hyalin deposits are unknown, but they probably represent a regressive phenomenon in longstanding or involuting lesions. Hyalinizing Spitz nevus must be included in the differential diagnosis of cutaneous lesions exhibiting a prominent hyalinized stroma and must be differentiated from other dermal neoplasms, particularly cutaneous metastases from occult internal malignancies and malignant melanoma.
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Affiliation(s)
- S Suster
- Arkadi M. Rywlin Department of Pathology & Laboratory Medicine, Mount Sinai Medical Center of Greater Miami, Florida
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Rădulescu D. Spindle and epithelioid cell nevus (Spitz nevus). Observation on nine cases. Rom J Morphol Embryol 1994; 40:15-8. [PMID: 7640369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Nine cases with spindle and epithelioid cell nevus occurred in children were analysed clinically and morphologically. The results indicate that Spitz nevus is composed of cells resembling those of a malignant melanoma. There are some morphological aspects such as: discontinuous junctional proliferation, the sparse mitotic activity, the process of maturation of the cells with increasing depth, considered as valuable markers for the benign character of this type of tumour.
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Affiliation(s)
- D Rădulescu
- Department of Morphopathology, University of Medicine and Pharmacy, Jassy, Romania
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