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Hypopigmented atypical Spitzoid neoplasms (atypical Spitz nevi, atypical Spitz tumors, Spitzoid melanoma): a clinicopathological update.

Ferrara G, Cavicchini S, Corradin MT - Dermatol Pract Concept (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Oncology, Anatomic Pathology Unit, Gaetano Rummo Hospital, Benevento, Italy.

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During the following forty years, however, the entity described by Sophie Spitz was thought to be completely benign, with metastasizing cases being intuitively considered as cases of melanomas simulating Spitz nevus (Spitzoid melanoma)... According to this view, the adjective “atypical” is redundant and useless, because any Spitz nevus is “atypical” by definition; nevertheless, it can be differentiated from its malignant simulator (i.e., Spitzoid melanoma) according to a well defined set of histologic criteria; every Spitzoid (and non-Spitzoid) melanocytic proliferation behaves as either a benign or a malignant neoplasm which we can be unable to correctly categorize simply because our brain can fail to correctly apply the diagnostic criteria... The first problem is purely morphologic: by assuming that Spitz nevus is a simulator of melanoma (Spitz nevus as a pseudomalignancy) and that melanoma resembling Spitz nevus is a simulator of its simulator (Spitzoid melanoma as a pseudo-pseudomalignancy), it is not surprising that the diagnosis of such lesions is a quandary even among experts who may be indeed unable to place an “I don’t know” lesion into a either “nevus” or “melanoma” category... Ackerman’s approach is biological... A tutorial held in Graz, Austria, in 2008 evaluated 57 melanocytic tumors of uncertain malignant potential, 35 of which being thick Spitzoid neoplasms: a panel of expert was unable to differentiate cases with favourable and unfavourable behaviour on morphologic grounds; therefore, it was concluded that the cases were all malignant, albeit clearly different from “conventional” melanoma because of a great thickness associated with a relatively low metastatic rate... A hypopigmented Spitzoid melanocytic neoplasm can be typified by at least one of the following: Homogeneous pink color: sometimes associated with a brownish hue or remnant(s) of brown pigmentation... In 2005, Urso performed a review of 19 papers reporting 62 Spitzoid neoplasms showing an aggressive biological behavior in spite of histopathologic features not enough for a diagnosis of clear-cut malignancy... Nine criteria were thus found to be predictive of metastatic potential: notably, such criteria were not the very same as for “conventional” melanoma and, most important, they had to be used in a completely different manner, because even the presence of one criterion could be virtually incompatible with benignity... In our experience, a diagnosis of Spitz nevus in the presence of a polymorphous vascular pattern must be made only under a compelling histopathological evidence of benignity; we have also suggested that when a given Spitzoid lesion is histopathologically atypical but its “grading” is uncertain, the presence of a highly atypical vascular pattern could point toward its management as a “tumor” instead of an “atypical nevus”... On the excision specimen, the “shoulder” of the neoplasm disclosed a bland morphology, featuring monomorphic spindle cells, probably representing a benign background (Spitz nevus) in which Spitzoid melanoma had been developing... The suggested management for both pediatric-type and adult-type Spitzoid melanoma is obviously the same as for “conventional” melanoma... The introduction of dermoscopy has significantly changed the clinical diorama of Spitzoid lesions... Since there are still many controversial points in the histopathologic categorization of these lesions, clinicopathologic correlation must be the mainstay for their diagnosis and proper management.

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Related in: MedlinePlus

A dome-shaped red lesion with a light verrucous surface (A) located on the back in a 7-year-old girl. Dermoscopy (B) suggests that the lesion is probably not a viral wart, because of the presence of a thick reticular depigmentation surrounding linear irregular vessels; some small white scales and a peripheral light brown symmetric pigmentation are visible as well. Histopathologically, the lesion is very atypical, with an asymmetric involvement of the epidermis (C, arrow) and a deep dermal component made by epitheloid (spitzoid) cells with a confluent pleomorphomism and a larger size than the overlying melanocytes (D). Histopathological diagnosis: Spitzoid melanoma, according to Ackerman’s classification [8]; Spitz tumor with atypical features, according to Banhill’s classification, 2006 [19]. Our histopathological diagnosis was (atypical) Spitz tumor. In this case, a sentinel node biopsy disclosed few parenchymal aggregates of pleomorphic melanocytes; no completion lymph node dissection was performed. The patient is alive with no evidence of disease after six years. (Copyright: ©2015 Ferrara et al.)
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f3-dp0501a06: A dome-shaped red lesion with a light verrucous surface (A) located on the back in a 7-year-old girl. Dermoscopy (B) suggests that the lesion is probably not a viral wart, because of the presence of a thick reticular depigmentation surrounding linear irregular vessels; some small white scales and a peripheral light brown symmetric pigmentation are visible as well. Histopathologically, the lesion is very atypical, with an asymmetric involvement of the epidermis (C, arrow) and a deep dermal component made by epitheloid (spitzoid) cells with a confluent pleomorphomism and a larger size than the overlying melanocytes (D). Histopathological diagnosis: Spitzoid melanoma, according to Ackerman’s classification [8]; Spitz tumor with atypical features, according to Banhill’s classification, 2006 [19]. Our histopathological diagnosis was (atypical) Spitz tumor. In this case, a sentinel node biopsy disclosed few parenchymal aggregates of pleomorphic melanocytes; no completion lymph node dissection was performed. The patient is alive with no evidence of disease after six years. (Copyright: ©2015 Ferrara et al.)

Mentions: The unique banal cutaneous lesion, which cannot be differentiated from a red Spitz tumor on the basis of dermoscopy, is pyogenic granuloma: this is the reason why always submit to histopathologic examination the curetted material of any pyogenic granuloma look-alike lesion. The quality of the vascular pattern is of paramount importance for the differential diagnosis of “red Spitz tumors” from more common and banal lesions, such as viral warts (Figure 3) and molluscum contagiosum (Figure 4). In our experience, a diagnosis of Spitz nevus in the presence of a polymorphous vascular pattern must be made only under a compelling histopathological evidence of benignity; we have also suggested that when a given Spitzoid lesion is histopathologically atypical but its “grading” is uncertain, the presence of a highly atypical vascular pattern could point toward its management as a “tumor” instead of an “atypical nevus” [17].


Hypopigmented atypical Spitzoid neoplasms (atypical Spitz nevi, atypical Spitz tumors, Spitzoid melanoma): a clinicopathological update.

Ferrara G, Cavicchini S, Corradin MT - Dermatol Pract Concept (2015)

A dome-shaped red lesion with a light verrucous surface (A) located on the back in a 7-year-old girl. Dermoscopy (B) suggests that the lesion is probably not a viral wart, because of the presence of a thick reticular depigmentation surrounding linear irregular vessels; some small white scales and a peripheral light brown symmetric pigmentation are visible as well. Histopathologically, the lesion is very atypical, with an asymmetric involvement of the epidermis (C, arrow) and a deep dermal component made by epitheloid (spitzoid) cells with a confluent pleomorphomism and a larger size than the overlying melanocytes (D). Histopathological diagnosis: Spitzoid melanoma, according to Ackerman’s classification [8]; Spitz tumor with atypical features, according to Banhill’s classification, 2006 [19]. Our histopathological diagnosis was (atypical) Spitz tumor. In this case, a sentinel node biopsy disclosed few parenchymal aggregates of pleomorphic melanocytes; no completion lymph node dissection was performed. The patient is alive with no evidence of disease after six years. (Copyright: ©2015 Ferrara et al.)
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4325689&req=5

f3-dp0501a06: A dome-shaped red lesion with a light verrucous surface (A) located on the back in a 7-year-old girl. Dermoscopy (B) suggests that the lesion is probably not a viral wart, because of the presence of a thick reticular depigmentation surrounding linear irregular vessels; some small white scales and a peripheral light brown symmetric pigmentation are visible as well. Histopathologically, the lesion is very atypical, with an asymmetric involvement of the epidermis (C, arrow) and a deep dermal component made by epitheloid (spitzoid) cells with a confluent pleomorphomism and a larger size than the overlying melanocytes (D). Histopathological diagnosis: Spitzoid melanoma, according to Ackerman’s classification [8]; Spitz tumor with atypical features, according to Banhill’s classification, 2006 [19]. Our histopathological diagnosis was (atypical) Spitz tumor. In this case, a sentinel node biopsy disclosed few parenchymal aggregates of pleomorphic melanocytes; no completion lymph node dissection was performed. The patient is alive with no evidence of disease after six years. (Copyright: ©2015 Ferrara et al.)
Mentions: The unique banal cutaneous lesion, which cannot be differentiated from a red Spitz tumor on the basis of dermoscopy, is pyogenic granuloma: this is the reason why always submit to histopathologic examination the curetted material of any pyogenic granuloma look-alike lesion. The quality of the vascular pattern is of paramount importance for the differential diagnosis of “red Spitz tumors” from more common and banal lesions, such as viral warts (Figure 3) and molluscum contagiosum (Figure 4). In our experience, a diagnosis of Spitz nevus in the presence of a polymorphous vascular pattern must be made only under a compelling histopathological evidence of benignity; we have also suggested that when a given Spitzoid lesion is histopathologically atypical but its “grading” is uncertain, the presence of a highly atypical vascular pattern could point toward its management as a “tumor” instead of an “atypical nevus” [17].

View Article: PubMed Central - PubMed

Affiliation: Department of Oncology, Anatomic Pathology Unit, Gaetano Rummo Hospital, Benevento, Italy.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

During the following forty years, however, the entity described by Sophie Spitz was thought to be completely benign, with metastasizing cases being intuitively considered as cases of melanomas simulating Spitz nevus (Spitzoid melanoma)... According to this view, the adjective “atypical” is redundant and useless, because any Spitz nevus is “atypical” by definition; nevertheless, it can be differentiated from its malignant simulator (i.e., Spitzoid melanoma) according to a well defined set of histologic criteria; every Spitzoid (and non-Spitzoid) melanocytic proliferation behaves as either a benign or a malignant neoplasm which we can be unable to correctly categorize simply because our brain can fail to correctly apply the diagnostic criteria... The first problem is purely morphologic: by assuming that Spitz nevus is a simulator of melanoma (Spitz nevus as a pseudomalignancy) and that melanoma resembling Spitz nevus is a simulator of its simulator (Spitzoid melanoma as a pseudo-pseudomalignancy), it is not surprising that the diagnosis of such lesions is a quandary even among experts who may be indeed unable to place an “I don’t know” lesion into a either “nevus” or “melanoma” category... Ackerman’s approach is biological... A tutorial held in Graz, Austria, in 2008 evaluated 57 melanocytic tumors of uncertain malignant potential, 35 of which being thick Spitzoid neoplasms: a panel of expert was unable to differentiate cases with favourable and unfavourable behaviour on morphologic grounds; therefore, it was concluded that the cases were all malignant, albeit clearly different from “conventional” melanoma because of a great thickness associated with a relatively low metastatic rate... A hypopigmented Spitzoid melanocytic neoplasm can be typified by at least one of the following: Homogeneous pink color: sometimes associated with a brownish hue or remnant(s) of brown pigmentation... In 2005, Urso performed a review of 19 papers reporting 62 Spitzoid neoplasms showing an aggressive biological behavior in spite of histopathologic features not enough for a diagnosis of clear-cut malignancy... Nine criteria were thus found to be predictive of metastatic potential: notably, such criteria were not the very same as for “conventional” melanoma and, most important, they had to be used in a completely different manner, because even the presence of one criterion could be virtually incompatible with benignity... In our experience, a diagnosis of Spitz nevus in the presence of a polymorphous vascular pattern must be made only under a compelling histopathological evidence of benignity; we have also suggested that when a given Spitzoid lesion is histopathologically atypical but its “grading” is uncertain, the presence of a highly atypical vascular pattern could point toward its management as a “tumor” instead of an “atypical nevus”... On the excision specimen, the “shoulder” of the neoplasm disclosed a bland morphology, featuring monomorphic spindle cells, probably representing a benign background (Spitz nevus) in which Spitzoid melanoma had been developing... The suggested management for both pediatric-type and adult-type Spitzoid melanoma is obviously the same as for “conventional” melanoma... The introduction of dermoscopy has significantly changed the clinical diorama of Spitzoid lesions... Since there are still many controversial points in the histopathologic categorization of these lesions, clinicopathologic correlation must be the mainstay for their diagnosis and proper management.

No MeSH data available.


Related in: MedlinePlus