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Sentinel Lymph Node Biopsy in Histologically Ambiguous Melanocytic Tumors With Spitzoid Features (So-Called Atypical Spitzoid Tumors)

  • Melanomas
  • Original Papers
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The distinction of Spitz nevi from melanomas with spitzoid morphology can be difficult. For lesions with overlapping histopathologic features, it may be impossible to predict their malignant potential with certainty. The current study evaluated the role of sentinel lymph node (SLN) biopsy in patients with such atypical spitzoid tumors.

Methods

The clinical and histopathologic features of 21 patients with atypical spitzoid tumors who underwent SLN biopsy were reviewed and correlated with the presence or absence of metastatic tumor in their corresponding SLNs.

Results

The atypical histopathologic features that were most frequently present included incomplete maturation (11 patients, 52%), two or more dermal mitoses per square millimeter (13 patients, 62%), and deep dermal mitoses (11 patients, 52%). Six patients (29%) showed SLN metastasis. There were histopathologic differences between tumors with positive SLN when compared with tumors with negative SLN: mean tumor thickness (3.38 mm vs. 2.04 mm), incomplete maturation (83% vs. 40%), median dermal mitotic rate (3.5/mm2 vs. 2/mm2), deep dermal mitoses (83% vs. 47%), and expansile dermal nodules (50% vs. 13%). However, of these, only the difference in mean tumor thickness reached statistical significance (P < .05).

Conclusions

SLN biopsy offers a means of assessing the metastatic potential of atypical spitzoid tumors and aids in the management of these patients by selecting patients who may benefit from a regional node field dissection and those in whom the use of adjuvant therapies could be considered.

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References

  1. Spitz S. Melanomas of childhood. Am J Pathol 1948;24:591–609

    CAS  PubMed  Google Scholar 

  2. Allen AC, Spitz S. Histogenesis and clinicopathologic correlation of nevi and malignant melanomas;current status. Arch Dermatol Syphilol 1954;69:150–71

    CAS  Google Scholar 

  3. Kernen JA, Ackerman LV. Spindle cell nevi and epithelioid cell nevi (so-called juvenile melanomas) in children and adults. a clinicopathologic study of 27 cases. Cancer 1960;13:612–25

    Article  PubMed  CAS  Google Scholar 

  4. Weedon D, Little JH. Spindle and epithelioid cell nevi in children and adults. A review of 211 cases of the Spitz nevus. Cancer 1977;40:217–25

    Article  PubMed  CAS  Google Scholar 

  5. Mooi WJ. Spitz nevus and its histologic simulators. Adv Anat Pathol 2002;9:209–21

    Article  PubMed  Google Scholar 

  6. Peters MS, Goellner JR. Spitz naevi and malignant melanomas of childhood and adolescence. Histopathology 1986;10:1289–302

    Article  PubMed  CAS  Google Scholar 

  7. Spatz A, Barnhill RL. The Spitz tumor 50 years later: revisiting a landmark contribution and unresolved controversy. J Am Acad Dermatol 1999;40(2 Pt 1):223–8

    Article  PubMed  CAS  Google Scholar 

  8. Su LD, Fullen DR, Sondak VK, et al. Sentinel lymph node biopsy for patients with problematic spitzoid melanocytic lesions: a report on 18 patients. Cancer 2003;97:499–507

    Article  PubMed  Google Scholar 

  9. Crotty KA. Spitz naevus: histological features and distinction from malignant melanoma (review). Australas J Dermatol 1997;38(Suppl 1):S49–53

    PubMed  Google Scholar 

  10. Crotty KA, Scolyer RA, Li L, et al. Spitz naevus versus spitzoid melanoma: when and how can they be distinguished? Pathology 2002;34:6–12

    Article  PubMed  Google Scholar 

  11. Walsh N, Crotty K, Palmer A, McCarthy S. Spitz nevus versus spitzoid malignant melanoma: an evaluation of the current distinguishing histopathologic criteria. Hum Pathol 1998;29:1105–12

    Article  PubMed  CAS  Google Scholar 

  12. McCarthy SW, Scolyer RA. Melanocytic lesions of the face: diagnostic pitfalls (review). Ann Acad Med Singapore 2004;33(4 Suppl):3–14

    PubMed  CAS  Google Scholar 

  13. Scolyer RA, Thompson JF, Stretch JR, et al. Pathology of melanocytic lesions: new, controversial, and clinically important issues. J Surg Oncol 2004;86:200–11

    Article  PubMed  Google Scholar 

  14. Barnhill RL, Argenyi ZB, From L, et al. Atypical Spitz nevi/tumors: lack of consensus for diagnosis, discrimination from melanoma, and prediction of outcome. Hum Pathol 1999;30:513–20

    Article  PubMed  CAS  Google Scholar 

  15. Cerroni L, Kerl H. Tutorial on melanocytic lesions (comment). Am J Dermatopathol 2001;23:237–41

    Article  PubMed  CAS  Google Scholar 

  16. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392–9

    PubMed  CAS  Google Scholar 

  17. Lohmann CM, Coit DG, Brady MS, et al. Sentinel lymph node biopsy in patients with diagnostically controversial spitzoid melanocytic tumors. Am J Surg Pathol 2002;26:47–55

    Article  PubMed  Google Scholar 

  18. Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 2006;355:1307–17

    Article  PubMed  CAS  Google Scholar 

  19. Dahlstrom JE, Scolyer RA, Thompson JF, Jain S. Spitz naevus: diagnostic problems and their management implications. Pathology 2004;36:452–7

    Article  PubMed  Google Scholar 

  20. Scolyer RA, Shaw HM, Thompson JF, et al. Interobserver reproducibility of histopathologic prognostic variables in primary cutaneous melanomas. Am J Surg Pathol 2003;27:1571–6

    Article  PubMed  Google Scholar 

  21. Yee VS, Thompson JF, McKinnon JG, et al. Outcome in 846 cutaneous melanoma patients from a single center after a negative sentinel node biopsy. Ann Surg Oncol 2005;12:429–39; [Erratum, Ann Surg Oncol 2005;12:843.]

    Article  PubMed  Google Scholar 

  22. Doubrovsky A, De Wilt JH, Scolyer RA, et al. Sentinel node biopsy provides more accurate staging than elective lymph node dissection in patients with cutaneous melanoma. Ann Surg Oncol 2004;11:829–36

    Article  PubMed  CAS  Google Scholar 

  23. Thompson JF. The Sydney Melanoma Unit experience of sentinel lymphadenectomy for melanoma. Ann Surg Oncol 2001;8(9 Suppl):44S–47S

    PubMed  CAS  Google Scholar 

  24. Okun MR. Melanoma resembling spindle and epithelioid cell nevus. Arch Dermatol 1979;115:1416–20

    Article  PubMed  CAS  Google Scholar 

  25. Smith KJ, Barrett TL, Skelton HG 3rd, et al. Spindle cell and epithelioid cell nevi with atypia and metastasis (malignant Spitz nevus). Am J Surg Pathol 1989;13:931–9

    Article  PubMed  CAS  Google Scholar 

  26. Cerroni L. A new perspective for spitz tumors? (comment). Am J Dermatopathol 2005;27:366–7

    Article  PubMed  Google Scholar 

  27. Crotty KA, McCarthy SW, Palmer AA, et al. Malignant melanoma in childhood: a clinicopathologic study of 13 cases and comparison with Spitz nevi. World J Surg 1992;16:179–85

    Article  PubMed  CAS  Google Scholar 

  28. McCarthy SW, Crotty KA, Palmer AA, et al. Cutaneous malignant melanoma in teenagers. Histopathology 1994;24:453–61

    Article  PubMed  CAS  Google Scholar 

  29. Urso C. A new perspective for spitz tumors? Am J Dermatopathol 2005;27:364–6

    Article  PubMed  Google Scholar 

  30. Urso C, Borgognoni L, Saieva C, et al. Sentinel lymph node biopsy in patients with “atypical Spitz tumors.” A report on 12 cases. Hum Pathol 2006;37:816–23

    Article  PubMed  Google Scholar 

  31. Spatz A, Calonje E, Handfield-Jones S, Barnhill RL. Spitz tumors in children: a grading system for risk stratification. Arch Dermatol 1999;135:282–5

    Article  PubMed  CAS  Google Scholar 

  32. Kelley SW, Cockerell CJ. Sentinel lymph node biopsy as an adjunct to management of histologically difficult to diagnose melanocytic lesions: a proposal. J Am Acad Dermatol 2000;42:527–30

    Article  PubMed  CAS  Google Scholar 

  33. Roaten JB, Partrick DA, Bensard D, et al. Survival in sentinel lymph node-positive pediatric melanoma. J Pediatr Surg 2005;40:988–92

    Article  PubMed  Google Scholar 

  34. Gurbuz Y, Apaydin R, Muezzinoglu B, Buyukbabani N. A current dilemma in histopathology: atypical spitz tumor or spitzoid melanoma? Pediatr Dermatol 2002;19:99–102

    Article  PubMed  Google Scholar 

  35. Zuckerman R, Maier JP, Guiney WB Jr, et al. Pediatric melanoma: confirming the diagnosis with sentinel node biopsy. Ann Plast Surg 2001;46:394–9

    Article  PubMed  CAS  Google Scholar 

  36. Gamblin TC, Edington H, Kirkwood JM, Rao UN. Sentinel lymph node biopsy for atypical melanocytic lesions with spitzoid features. Ann Surg Oncol 2006;13:1664–70

    Article  PubMed  Google Scholar 

  37. Cook MG, Green MA, Anderson B, et al. The development of optimal pathological assessment of sentinel lymph nodes for melanoma. J Pathol 2003;200:314–9

    Article  PubMed  Google Scholar 

  38. Sondak VK, Taylor JM, Sabel MS, et al. Mitotic rate and younger age are predictors of sentinel lymph node positivity: lessons learned from the generation of a probabilistic model. Ann Surg Oncol 2004;11:247–58

    Article  PubMed  Google Scholar 

  39. Thompson JF, Shaw HM. Should tumor mitotic rate and patient age, as well as tumor thickness, be used to select melanoma patients for sentinel node biopsy? (comment). Ann Surg Oncol 2004;11:233–5

    Article  PubMed  Google Scholar 

  40. Mihic-Probst D, Perren A, Schmid S, et al. Absence of BRAF gene mutations differentiates spitz nevi from malignant melanoma. Anticancer Res 2004;24:2415–8

    PubMed  CAS  Google Scholar 

  41. Gill M, Cohen J, Renwick N, et al. Genetic similarities between Spitz nevus and spitzoid melanoma in children. Cancer 2004;101:2636–40

    Article  PubMed  Google Scholar 

  42. Gill M, Renwick N, Silvers DN, Celebi JT. Lack of BRAF mutations in Spitz nevi. J Invest Dermatol 2004;122:1325–6

    Article  PubMed  Google Scholar 

  43. Bastian BC, LeBoit PE, Pinkel D. Mutations and copy number increase of HRAS in Spitz nevi with distinctive histopathological features. Am J Pathol 2000;157:967–72

    PubMed  CAS  Google Scholar 

  44. Bastian BC, Wesselmann U, Pinkel D, Leboit PE. Molecular cytogenetic analysis of Spitz nevi shows clear differences to melanoma. J Invest Dermatol 1999;113:1065–9

    Article  PubMed  CAS  Google Scholar 

  45. Bastian BC. Molecular genetics of melanocytic neoplasia: practical applications for diagnosis. Pathology 2004;36:458–61

    Article  PubMed  CAS  Google Scholar 

  46. Piepkorn M. The Spitz nevus is melanoma. Am J Dermatopathol 2005;27:367–9

    Article  PubMed  Google Scholar 

  47. Elder DE, Xu X. The approach to the patient with a difficult melanocytic lesion. Pathology 2004;36:428–34

    Article  PubMed  Google Scholar 

  48. Ackerman AB. Garble that derives from lack of definition. Am J Dermatopathol 2005;27:369–70

    Article  PubMed  Google Scholar 

  49. Bouffard D, Barnhill RL, Mihm MC, Sober AJ. Very late metastasis (27 years) of cutaneous malignant melanoma arising in a halo giant congenital nevus. Dermatology 1994;189:162–6

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Helen Shaw, Marjorie Colman, and the staff of the Department of Anatomical Pathology and the Sydney Melanoma Unit, Royal Prince Alfred Hospital, for their invaluable assistance. We also acknowledge the contributions of P. Bannatyne, I. Burchett, J. Burn, A. Cachia, S. Clark, R. Dixon, C. Douglas, S. Fairy, S. Fernando, A. Fischer, M. Fulton, B. Goodman, V. Howard, J. Judd, R. Lightfoot, D. Maynard, L. Peart, P. Restall, G. Rhodes, B. Rogleff, K. Singh, I. Strungs, and L. Tobiansky. The support of the Cancer Institute NSW Clinical Research Fellowship Program (R.M.), the University of Sydney Cancer Research Fund, the Australian National Health and Medical Research Council, and the Melanoma Foundation, University of Sydney, is also gratefully acknowledged.

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Authors and Affiliations

  1. Sydney Melanoma Unit, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, 2050, Australia

    Rajmohan Murali MBBS, FRCPA, John F. Thompson MD, FRACS, FACS, Jonathan R. Stretch MBBS, DPhil, FRACS & Richard A. Scolyer MD, FRCPA, FRCPath

  2. Melanoma and Skin Cancer Research Institute, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, 2050, Australia

    Rajmohan Murali MBBS, FRCPA, John F. Thompson MD, FRACS, FACS, Jonathan R. Stretch MBBS, DPhil, FRACS, Stanley W. McCarthy MBBS, FRCPA & Richard A. Scolyer MD, FRCPA, FRCPath

  3. Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, 2050, Australia

    Rajmohan Murali MBBS, FRCPA, C. Soon Lee MD, FRCPA, FRCPath, Stanley W. McCarthy MBBS, FRCPA & Richard A. Scolyer MD, FRCPA, FRCPath

  4. Department of Anatomical Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, Sydney, NSW, 2145, Australia

    Raghwa N. Sharma MBBS, FRCPA

  5. Discipline of Surgery, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia

    John F. Thompson MD, FRACS, FACS & Jonathan R. Stretch MBBS, DPhil, FRACS

  6. Discipline of Pathology, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia

    Rajmohan Murali MBBS, FRCPA, C. Soon Lee MD, FRCPA, FRCPath, Stanley W. McCarthy MBBS, FRCPA & Richard A. Scolyer MD, FRCPA, FRCPath

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  1. Rajmohan Murali MBBS, FRCPA
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  2. Raghwa N. Sharma MBBS, FRCPA
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Correspondence to John F. Thompson MD, FRACS, FACS.

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Murali, R., Sharma, R.N., Thompson, J.F. et al. Sentinel Lymph Node Biopsy in Histologically Ambiguous Melanocytic Tumors With Spitzoid Features (So-Called Atypical Spitzoid Tumors). Ann Surg Oncol 15, 302–309 (2008). https://doi.org/10.1245/s10434-007-9577-3

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  • DOI: https://doi.org/10.1245/s10434-007-9577-3

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