Clinical features and outcomes of spitzoid proliferations in children and adolescents.
Adolescent
Biopsy
Cell Proliferation
Child
Child, Preschool
Diagnosis, Differential
Female
Follow-Up Studies
Humans
Male
Melanoma
/ diagnosis
Nevus, Epithelioid and Spindle Cell
/ diagnosis
Retrospective Studies
Sentinel Lymph Node Biopsy
Skin
/ diagnostic imaging
Skin Neoplasms
/ diagnosis
Treatment Outcome
Young Adult
Journal
The British journal of dermatology
ISSN: 1365-2133
Titre abrégé: Br J Dermatol
Pays: England
ID NLM: 0004041
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
accepted:
19
11
2018
pubmed:
24
11
2018
medline:
2
10
2020
entrez:
24
11
2018
Statut:
ppublish
Résumé
Spitzoid proliferations range from Spitz naevi to melanomas. There are few studies describing clinical features and outcomes in the paediatric population. To determine the clinical features and outcomes of a large paediatric cohort with histopathologically confirmed Spitz tumours. This was a retrospective cohort study of patients seen at Boston Children's Hospital who were aged < 20 years and had a histopathological diagnosis of spitzoid proliferation from 1 January 1994 to 23 October 2012. In total 595 patients with 622 spitzoid proliferations were identified (median age 7·4 years, interquartile range 4·6-11·7). Overall 512 proliferations (82·3%) were typical, 107 (17·2.%) were atypical and three (0·5%) were melanomas. The median ages at biopsy were 7·4, 7·2 and 17·2 years, respectively, and there was a significant difference in age at biopsy for patients with typical or atypical proliferations vs. melanoma (P < 0·01). Among samples with positive margins (n = 153), 55% (54 of 98) of typical proliferations, 77% (41 of 53) of atypical proliferations and 100% (two of two) of melanomas were re-excised. Six patients had sentinel lymph node biopsy performed, with three patients demonstrating nodes positive for melanocytic cells. Within a median follow-up of 4·1 years for the full cohort there were no related deaths. Spitz tumours have strikingly benign outcomes in the paediatric population, although this study is limited by the low number of melanomas and restriction to a single paediatric institution. Aggressive management recommendations should be reconsidered for children and adolescents with banal-appearing Spitz naevi, based on the clinically indolent behaviour in this cohort.
Sections du résumé
BACKGROUND
Spitzoid proliferations range from Spitz naevi to melanomas. There are few studies describing clinical features and outcomes in the paediatric population.
OBJECTIVES
To determine the clinical features and outcomes of a large paediatric cohort with histopathologically confirmed Spitz tumours.
METHODS
This was a retrospective cohort study of patients seen at Boston Children's Hospital who were aged < 20 years and had a histopathological diagnosis of spitzoid proliferation from 1 January 1994 to 23 October 2012.
RESULTS
In total 595 patients with 622 spitzoid proliferations were identified (median age 7·4 years, interquartile range 4·6-11·7). Overall 512 proliferations (82·3%) were typical, 107 (17·2.%) were atypical and three (0·5%) were melanomas. The median ages at biopsy were 7·4, 7·2 and 17·2 years, respectively, and there was a significant difference in age at biopsy for patients with typical or atypical proliferations vs. melanoma (P < 0·01). Among samples with positive margins (n = 153), 55% (54 of 98) of typical proliferations, 77% (41 of 53) of atypical proliferations and 100% (two of two) of melanomas were re-excised. Six patients had sentinel lymph node biopsy performed, with three patients demonstrating nodes positive for melanocytic cells. Within a median follow-up of 4·1 years for the full cohort there were no related deaths.
CONCLUSIONS
Spitz tumours have strikingly benign outcomes in the paediatric population, although this study is limited by the low number of melanomas and restriction to a single paediatric institution. Aggressive management recommendations should be reconsidered for children and adolescents with banal-appearing Spitz naevi, based on the clinically indolent behaviour in this cohort.
Identifiants
pubmed: 30467833
doi: 10.1111/bjd.17450
pmc: PMC6531374
mid: NIHMS998713
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
366-372Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001102
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2018 British Association of Dermatologists.
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