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Sainz-Gaspar L, Sánchez-Bernal J, Noguera-Morel L, Hernández-Martín A, Colmenero I, Torrelo A. Nevo de Spitz y otros tumores spitzoides en la infancia. Parte 1: aspectos clínicos, histológicos e inmunohistoquímicos. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:7-19. [DOI: 10.1016/j.ad.2019.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/03/2019] [Indexed: 11/25/2022] Open
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Sainz-Gaspar L, Sánchez-Bernal J, Noguera-Morel L, Hernández-Martín A, Colmenero I, Torrelo A. Spitz Nevus and Other Spitzoid Tumors in Children —Part 1: Clinical, Histopathologic, and Immunohistochemical Features. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Hillen LM, Van den Oord J, Geybels MS, Becker JC, Zur Hausen A, Winnepenninckx V. Genomic Landscape of Spitzoid Neoplasms Impacting Patient Management. Front Med (Lausanne) 2018; 5:344. [PMID: 30619857 PMCID: PMC6300473 DOI: 10.3389/fmed.2018.00344] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/23/2018] [Indexed: 12/27/2022] Open
Abstract
Spitzoid neoplasms are a distinct group of melanocytic proliferations characterized by epithelioid and/ or spindle shaped melanocytes. Intermediate forms that share features of both benign Spitz nevi (SN) and Spitz melanoma, i.e., malignant Spitz tumor (MST) represent a diagnostically and clinically challenging group of melanocytic lesions. A multitude of descriptive diagnostic terms exist for these ambiguous lesions with atypical Spitz tumor (AST) or Spitz tumor of uncertain malignant potential (STUMP) just naming two of them. This diagnostic gray zone creates confusion and high insecurity in clinicians and in patients. Biological behavior and clinical course of this intermediate group still remains largely unknown, often leading to difficulties with uncertainties in clinical management and prognosis. Consequently, a better stratification of Spitzoid neoplasms in benign and malignant forms is required thereby keeping the diagnostic group of AST/STUMP as small as possible. Ancillary diagnostic techniques such as immunohistochemistry, comparative genomic hybridization, fluorescence in situ hybridization, next generation sequencing, micro RNA and mRNA analysis as well as mass spectrometry imaging offer new opportunities for the distinct diagnosis, thereby allowing the best clinical management of Spitzoid neoplasms. This review gives an overview on these additional diagnostic techniques and the recent developments in the field of molecular genetic alterations in Spitzoid neoplasms. We also discuss how the recent findings might facilitate the diagnosis and stratification of atypical Spitzoid neoplasms and how these findings will impact the diagnostic work up as well as patient management. We suggest a stepwise implementation of ancillary diagnostic techniques thereby integrating immunohistochemistry and molecular pathology findings in the diagnosis of challenging ambiguous Spitzoid neoplasms. Finally, we will give an outlook on pending future research objectives in the field of Spitzoid melanocytic lesions.
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Affiliation(s)
- Lisa M Hillen
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Joost Van den Oord
- Laboratory for Translational Cell and Tissue Research, Department of Pathology, KU Leuven, Leuven, Belgium
| | - Milan S Geybels
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Jürgen C Becker
- Institute for Translational Skin Cancer Research, German Cancer Consortium (DKTK), Partner Site Essen, University Hospital Essen, Essen, Germany
| | - Axel Zur Hausen
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Véronique Winnepenninckx
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
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Plexiform Atypical Spitz Tumor With Rosette-Like Giant Cells: A Histologic and Immunohistochemical Study on a Case Suggesting Ganglioneuroblastic Differentiation: Review of the Literature and Considerations on Histogenesis. Am J Dermatopathol 2018; 40:903-907. [DOI: 10.1097/dad.0000000000001184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Malkan AD, Sandoval JA. Controversial tumors in pediatric surgical oncology. Curr Probl Surg 2014; 51:478-520. [PMID: 25524425 DOI: 10.1067/j.cpsurg.2014.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/17/2014] [Indexed: 12/13/2022]
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McCormack CJ, Conyers RK, Scolyer RA, Kirkwood J, Speakman D, Wong N, Kelly JW, Henderson MA. Atypical Spitzoid neoplasms: a review of potential markers of biological behavior including sentinel node biopsy. Melanoma Res 2014; 24:437-47. [PMID: 24892957 DOI: 10.1097/cmr.0000000000000084] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Atypical cutaneous melanocytic lesions, including those with Spitzoid features, can be difficult to categorize as benign or malignant. This can lead to suboptimal management, with potential adverse patient outcomes. Recent studies have enhanced knowledge of the molecular and genetic biology of these lesions and, combined with clinicopathological findings, is further defining their biological spectrum, classification, and behavior. Sentinel node biopsy provides important prognostic information in patients with cutaneous melanoma, but its role in the management of melanocytic lesions of uncertain malignant potential (MELTUMP) is controversial. This paper examines the role of molecular testing and sentinel node biopsy in MELTUMPs, particularly atypical Spitzoid tumors.
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Affiliation(s)
- Christopher J McCormack
- aPeter Macallum Cancer Institute, East Melbourne bVictorian Melanoma Service, Alfred Hospital, Prahran cDepartment of Paediatrics, Murdoch Children's Research Institute, Royal Children's Hospital, The University of Melbourne, Parkville dThe Royal Children's Hospital, Flemington Road, Parkville, Victoria eMelanoma Institute Australia , Royal Prince Alfred Hospital, The University of Sydney, Sydney, New South Wales, Australia fDepartment of Medicine, Melanoma and Skin Cancer Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA
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7
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The surgical management of Spitz naevi and atypical spitzoid neoplasms: A review of the literature. Surgeon 2013; 11:205-9. [DOI: 10.1016/j.surge.2013.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 12/17/2012] [Accepted: 01/01/2013] [Indexed: 11/21/2022]
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8
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Luo S, Sepehr A, Tsao H. Spitz nevi and other Spitzoid lesions part I. Background and diagnoses. J Am Acad Dermatol 2011; 65:1073-84. [PMID: 22082838 DOI: 10.1016/j.jaad.2011.04.040] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 04/21/2011] [Accepted: 04/23/2011] [Indexed: 02/07/2023]
Abstract
Spitz nevi are melanocytic proliferations that are characterized by spindled and/or epithelioid nevomelanocytes. First interpreted as juvenile melanoma, these lesions were later characterized as benign and were observed to affect all age groups. Today, contrasting opinions persist regarding the fundamental benignancy versus malignancy within the spectrum of Spitz tumors. Beyond clinical outcome, this controversy has also been fueled by complex and sometimes convoluted classification schemes based on pathologic characteristics. More recently, immunophenotypic and molecular analyses have begun to clarify the etiologic nature of these tumors. Recent evidence suggests that histopathologic features that suggest more aggressiveness in Spitz tumors relate to mitoses and inflammation.
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Affiliation(s)
- Su Luo
- Wellman Center for Photomedicine and Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Barnhill RL. The Spitzoid lesion: rethinking Spitz tumors, atypical variants, 'Spitzoid melanoma' and risk assessment. Mod Pathol 2006; 19 Suppl 2:S21-33. [PMID: 16446713 DOI: 10.1038/modpathol.3800519] [Citation(s) in RCA: 190] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
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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Affiliation(s)
- Raymond L Barnhill
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL 33104, USA.
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Li LXL, Crotty KA, Scolyer RA, Thompson JF, Kril JJ, Palmer AA, McCarthy SW. Use of multiple cytometric markers improves discrimination between benign and malignant melanocytic lesions. Melanoma Res 2003; 13:581-6. [PMID: 14646621 DOI: 10.1097/00008390-200312000-00007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Confident separation of benign naevi and malignant melanoma can sometimes be very difficult using conventional microscopy. This study evaluated the combined diagnostic abilities of multiple cytometric markers in separating various types of naevi from melanomas. The lesions studied included 27 benign compound naevi, 20 dysplastic naevi, 10 Spitz naevi and 24 melanomas. The cytometric features investigated were: (i) nuclear DNA content and chromatin compactness, measured by video imaged DNA microdensitometry; (ii) nuclear morphology, measured by nuclear morphometry (karyometry); (iii) transcriptional activity of nucleolar organizer regions, measured as the number and size of argyrophilic staining of nucleolar organizer regions (AgNORs); and (iv) cellular proliferative activity detected by quantifying the immunoreactivity of MIB1-Ki67 antigen. These variables were evaluated in the superficial, middle and deep zones of each lesion. Using multivariate discriminant analysis, a total diagnostic effectiveness of 97% could be achieved in separating the benign and malignant melanocytic lesions by co-evaluating variables for DNA microdensitometry, karyometry and AgNORs. A diagnostic effectiveness of 100% could be achieved if further co-evaluation with MIB1-Ki67 immunoreactivity was performed. Our study suggests that co-evaluation of multiple cytometric markers can improve the diagnostic abilities of individual techniques in separating benign naevi from malignant melanomas. This may be of particular significance in the diagnosis of melanocytic lesions whose biological behaviour cannot be confidently predicted by their histological features using conventional microscopy.
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Affiliation(s)
- Ling-Xi L Li
- Melanoma and Skin Cancer Research Institute, Sydney Melanoma Unit and Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
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Spatz A, Barnhill RL. The Spitz tumor 50 years later: revisiting a landmark contribution and unresolved controversy. J Am Acad Dermatol 1999; 40:223-8. [PMID: 10025749 DOI: 10.1016/s0190-9622(99)70192-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- A Spatz
- Department of Pathology, Institut Gustave-Roussy, Villejuif, France
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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. [PMID: 9781649 DOI: 10.1016/s0046-8177(98)90421-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because of the well-known difficulty in distinguishing between Spitz nevi and spitzoid malignant melanomas at the microscopic level, the critical importance of this task notwithstanding, expert dermatopathologists across the world have strenuously endeavored to identify histopathologic criteria that would assist microscopists in this effort. Many reports itemizing such criteria are extant. The objective of the current study was to determine which of these criteria serve as the most consistent discriminators. Using a population of 11 spitzoid melanomas and 12 Spitz nevi, we evaluated six sets of criteria purported to be helpful in differentiating between these entities. Overall, we found that six features had significant distinguishing capacity, namely, (1) Kamino bodies, (2) a brisk mitotic rate, (3) mitoses close to the base of the lesion, (4) abnormal mitoses, (5) symmetry, and (6) uniformity of nests from side to side. It is noteworthy that the first three of these rank among the six criteria itemized repeatedly in 50% or more of the sets of criteria evaluated.
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Affiliation(s)
- N Walsh
- Department of Anatomical Pathology, Royal Prince Alfred Hospital and the University of Sydney, Australia
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Kim HR, Kim YJ. Neurofibromatosis of the colon and rectum combined with other manifestations of von Recklinghausen's disease: report of a case. Dis Colon Rectum 1998; 41:1187-92. [PMID: 9749504 DOI: 10.1007/bf02239443] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Gastrointestinal involvement of neurofibromatosis occurs in as many as 25 percent of cases. Neurofibroma occurs most frequently in the stomach and jejunum, but the colon may also be involved. This condition is characterized by multiple submucosal neurofibromas of the gastrointestinal tract and café au lait pigmentation, bony abnormalities, and neurofibromas of both central and peripheral nerves. The lesions consist of an overgrowth of neural tissue along with other mesenchymal elements. Gastrointestinal neurofibromas may cause occult bleeding, luminal obstruction, or intussusception. Malignant transformation into neurofibrosarcoma is rare. We encountered a case of neurofibromatosis diffusely involving the left colon, the sigmoid colon, and the rectum, which resulted in herniation of the mass through the anus, with intestinal obstruction. The patient also showed skin lesions of the neurofibromatosis. We report this case with a review of the literature.
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Affiliation(s)
- H R Kim
- Department of Surgery, Chonnam University Medical School, Kwangju, Korea
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Orchard DC, Dowling JP, Kelly JW. Spitz naevi misdiagnosed histologically as melanoma: prevalence and clinical profile. Australas J Dermatol 1997; 38:12-4. [PMID: 9046646 DOI: 10.1111/j.1440-0960.1997.tb01091.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A Spitz naevus is a benign melanocytic tumour that may histologically resemble a malignant melanoma. Data was retrospectively gathered from patients who attended the Victorian Melanoma Service to determine the prevalence of Spitz naevi pathologically misdiagnosed as melanoma. Assessment of the clinical characteristics of these patients was also performed and compared to those with correctly diagnosed melanoma. It was found that 6.5% of all melanomas referred were in fact Spitz naevi and that Spitz naevi represented the majority of pathologically misdiagnosed melanomas. The Spitz naevi were more likely to be on the lower extremities and were no average, considerably smaller than the melanomas. Patients with Spitz naevi were more likely to be younger, female, have fewer dysplastic naevi and have brown eyes. One hundred per cent of the Spitz naevi were brought to the attention of the initial doctor by the patient compared to 72% of the melanomas. This study concludes that Spitz naevi that are pathologically misdiagnosed as melanomas retain the clinical characteristics of other Spitz naevi and that greater clinicopathological communication may reduce the frequency of diagnostic error.
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Affiliation(s)
- D C Orchard
- Victorian Melanoma Service, Alfred Health Care Group, Prahran, Australia
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Vogt T, Stolz W, Glässl A, Abmayr W, Hohenleutner U, Schmoeckel C, Schiffner R, Landthaler M. Multivariate DNA cytometry discriminates between Spitz nevi and malignant melanomas because large polymorphic nuclei in Spitz nevi are not aneuploid. Am J Dermatopathol 1996; 18:142-50. [PMID: 8739988 DOI: 10.1097/00000372-199604000-00006] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
To elucidate the reasons for the malignant histologic appearance of melanocytic nuclei within benign Spitz nevi (SN), we evaluated nuclear DNA distribution and nuclear size using a computerized image analysis system. In each case of 28 SN and 34 malignant melanomas (MM), about 100 randomly sampled nuclei were analyzed, prepared as monolayers from paraffin-embedded tissues. Large nuclei in MM (nuclear area > mean nuclear area of normal melanocytes + 4 delta) were significantly more likely to be aneuploid (DNA content > or = 5c) than large nuclei in SN chi2 test, p < 0.0001). Only two of 990 large SN nuclei exhibited DNA values higher than 5c, whereas 236 of 2,024 large MM nuclei were aneuploid or polyploid. Accordingly, in multivariate analysis, five features of DNA distribution proved to be most important for objective discrimination between MM and SN: 2c deviation index, 5c exceeding rate, standard deviation of the nuclear DNA content, and both the 85th and the 95th percentiles of DNA distributions. On the basis of these features, we could define a linear discriminant function that allowed a correct diagnosis in 94% of the cases. Our data demonstrate that diagnostically misleading large nuclei in SN are euploid, in contrast to MM. It is thus possible to discriminate SN and MM with high accuracy using DNA cytometry. Because paraffin-embedded tissue can be used, this technique could be a valuable complement to routine histology in equivocal cases.
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Affiliation(s)
- T Vogt
- Department of Dermatology, University of Regensburg, Germany
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Fleming MG. Image analysis in dermatopathology. Skin Res Technol 1995; 1:163-72. [PMID: 27326717 DOI: 10.1111/j.1600-0846.1995.tb00038.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIMS Image analysis in dermatopathology has been used for DNA ploidy analysis, morphometry, stereology, and quantitative immunohistochemistry. The object is to review image analysis in dermatopathology and evaluate these modalities and their application in pigmented lesion pathology, for elucidation of tumor behaviour and architecture and as an aid in tumor identification and prognostication. CONCLUSION Image analysis in dermapathology has a huge potential. The techniques are difficult and at present mainly used in specialized centres.
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Affiliation(s)
- M G Fleming
- Departments of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
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De Wit PE, Kerstens HM, Poddighe PJ, Van Muijen GN, Ruiter DJ. DNA in situ hybridization as a diagnostic tool in the discrimination of melanoma and Spitz naevus. J Pathol 1994; 173:227-33. [PMID: 7931843 DOI: 10.1002/path.1711730305] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
As the clinical and histological differential diagnosis between Spitz naevus and cutaneous melanoma may be very difficult, we have investigated whether DNA in situ hybridization maybe helpful in resolving this problem. To this end, routinely-processed paraffin sections of 15 typical Spitz naevi, 15 typical nodular melanomas, and five cases originally misdiagnosed as Spitz naevi but which later metastasized and were reclassified as melanoma were analysed using a method previously described (De Wit et al., J Invest Dermatol 1992; 98: 450-458). Microscopical semi-quantitative evaluation revealed that the number of nuclei with supernumerary aberrations of the centromere region of chromosome 1, suggestive of aneuploidy, was significantly different in Spitz naevi and nodular melanoma. The mean number of aberrant nuclei per high power field was 0.41 and 4.01, respectively (P = 0.0001). On applying the results of the typical lesions to the equivocal, originally misdiagnosed lesions, three out of five could be identified as melanoma. These results suggest that the application of DNA in situ hybridization may contribute to the positive identification of histologically equivocal pigmented lesions. The advantages of this technique are that it is cheap, requires little tissue, and can be applied on routinely-processed paraffin sections.
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Affiliation(s)
- P E De Wit
- Department of Pathology, University Hospital Nijmegen, The Netherlands
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Stolz W, Vogt T, Landthaler M, Hempfer S, Bingler P, Abmayr W. Differentiation between malignant melanomas and benign melanocytic nevi by computerized DNA cytometry of imprint specimens. J Cutan Pathol 1994; 21:7-15. [PMID: 8188937 DOI: 10.1111/j.1600-0560.1994.tb00684.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Recently image analysis (IA) and DNA-cytophotometry (CP) have proved to be useful for the differentiation between benign and malignant melanocytic lesions on paraffin sections. Since, on sections, these procedures are very time-consuming, we tested in the present study whether IA of imprint specimens, which can be evaluated in less than 30 minutes, might also be sufficient. In 39 malignant melanomas (MM), 18 melanocytic nevi (MN), and 6 dysplastic nevi (DN), 12 different morphometric and DNA cytometric features were determined in 100 randomly selected nuclei. In univariate analysis, 5 features were found to be significantly different between the benign and malignant groups (p < 0.0001): mean value (MAREA) and standard deviation (SAREA) of nuclear area and the 80th, 90th, and 95th percentiles of DNA distribution. Using SAREA, the best univariate feature, 82.5% of the cases could be correctly separated. In multivariate analysis with a combination of three features--standard deviation of nuclear area (SAREA), mean DNA value (MDNA), and 95th percentile of DNA distribution (PERC95)--a correct diagnosis was achieved in 89.5% of the cases. Results obtained in the cases of DN indicated an increased proliferation, but did not allow the separation of DN from MM and MN. Since our technique allows a rapid analysis without loss of tissue, which might be important for histological analysis, and the classification rates are equal or still higher than reported in studies on sections, imprints of melanocytic lesions seem to be most appropriate for the calculation of DNA cytometric features as helpful diagnostic criteria in equivocal melanocytic lesions.
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Affiliation(s)
- W Stolz
- Department of Dermatology, University of Regensburg, Germany
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Abstract
BACKGROUND The Spitz nevus is a rare form of benign nevus, which may be confused with malignant melanoma. METHODS We reviewed the clinical and histologic features of 29 cases of Spitz nevus, of which 20 were dealt with by our department of dermatology at the Hull Royal Infirmary between 1969 and 1990. The other nine cases were from the records of our pathology department dated between 1979 and 1991, of which seven of the lesions were excised by the surgeons and two by the general practitioners. RESULTS In all the cases, the final diagnosis was established histologically. In three cases, there were difficulties histologically in excluding the diagnosis of malignant melanoma. All the lesions were solitary, and none of the lesions recurred following excision despite the possibility of incomplete excision in some cases. CONCLUSIONS We found the size of the lesion and the age of the patient important factors to consider in the diagnosis of Spitz nevus. The small number of cases we encountered over a period of 22 years in a department that serves a population of around 500,000 emphasises the rarity of the condition.
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Affiliation(s)
- C B Ko
- Department of Dermatology, Hull Royal Infirmary, United Kingdom
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Abramovits W, Gonzalez-Serva A. Multiple agminated pigmented Spitz nevi (mimicking acral lentiginous malignant melanoma and dysplastic nevus) in an African-American girl. Int J Dermatol 1993; 32:280-5. [PMID: 8486460 DOI: 10.1111/j.1365-4362.1993.tb04268.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Reed's nevi are distinguished from Sptiz tumors by their significant melanogenesis and growth pattern. They may be confused with melanoma on clinical and histologic grounds. CASE REPORT An unusual case in which multiple agminated Reed's nevi mimicked acral lentiginous malignant melanoma in an African-American girl is presented. A critical review of the literature is presented to assist in the diagnosis. CONCLUSIONS Awareness of this entity and of its possible clinical presentations and judicious application of conventional hematoxylin-eosin microscopic criteria remain the most useful methods to bring the correct diagnosis in most instances. Mutilating or excessive surgery may be avoided for most cases of pigmented spindle and epithelioid cell nevus.
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Affiliation(s)
- W Abramovits
- Valley International Dermatology Associates, McAllen, Texas
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Immunophenotyping of Compound and Spitz Nevi and Vertical Growth-Phase Melanomas Using a Panel of Monoclonal Antibodies Reactive in Paraffin Sections. J Invest Dermatol 1993. [DOI: 10.1038/jid.1993.54] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lazzaro B, Elder DE, Rebers A, Power L, Herlyn M, Menrad A, Johnson B. Immunophenotyping of compound and spitz nevi and vertical growth-phase melanomas using a panel of monoclonal antibodies reactive in paraffin sections. J Invest Dermatol 1993; 100:313S-317S. [PMID: 8440911 DOI: 10.1111/1523-1747.ep12470206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- B Lazzaro
- Wistar Institute, Philadelphia, Pennsylvania
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