Atypical Spitz tumours: an epidemiological, clinical and dermoscopic multicentre study with 16 years of follow-up.
Journal
Clinical and experimental dermatology
ISSN: 1365-2230
Titre abrégé: Clin Exp Dermatol
Pays: England
ID NLM: 7606847
Informations de publication
Date de publication:
Aug 2022
Aug 2022
Historique:
revised:
24
01
2022
received:
02
11
2021
accepted:
31
01
2022
pubmed:
7
2
2022
medline:
28
7
2022
entrez:
6
2
2022
Statut:
ppublish
Résumé
Atypical Spitz tumours (ASTs) are regarded as an intermediate category distinguished from prototypical Spitz naevus by presenting one or more atypical features and often by an uncertain malignant potential. Clinical and dermoscopic features may play a relevant role in the diagnostic approach. To evaluate the clinical and dermoscopic features of ASTs, and their evolution over time. This was a descriptive, multicentre study of the clinical and dermoscopic characteristics of ASTs. Data on clinical and dermoscopic characteristics, histopathology, local extension, therapy and follow-up, lymph node staging, complete lymph node dissection, and outcome were collected from the databases of four Italian Dermatology Units for the period 2004-2021. The study population consisted of 99 patients (62 female, 37 male) with a histologically confirmed diagnosis of AST, including age at presentation ranged from 2 to 70 years (mean 28.1 years, median 24 years). Of the 99 patients, 29 (29.3%) underwent sentinel lymph node biopsy, which showed evidence of micrometastases in three cases (10.3%); all three patients underwent complete lymph node dissection with no evidence of further metastasis. Considering the whole study population, the clinical outcome was excellent, as all of the patients have no evidence of recurrence or distant metastasis. The follow-up period ranged from 6 to 216 months (mean 81.6 months, median 78 months). In addition, we collected data on the clinical and dermoscopic features of 26 lesions. The most frequent dermoscopic pattern observed was the multicomponent pattern (34.6%), followed by homogeneous (26.9%) and nonspecific (23.2%). In 66.7% of amelanotic ASTs, we observed glomerular (coiled) vessels uniformly distributed within the entire lesion, without asymmetry. The results of our study with a long follow-up show no recurrence or distant metastases, confirming the good clinical outcome, even in the case of sentinel lymph node positivity. From a diagnostic point of view, our series identified a typical dermoscopic picture for amelanotic ASTs, with a glomerular vascular pattern throughout the lesion in the absence of other dermoscopic parameters, making the correct diagnosis possible.
Sections du résumé
BACKGROUND
BACKGROUND
Atypical Spitz tumours (ASTs) are regarded as an intermediate category distinguished from prototypical Spitz naevus by presenting one or more atypical features and often by an uncertain malignant potential. Clinical and dermoscopic features may play a relevant role in the diagnostic approach.
AIM
OBJECTIVE
To evaluate the clinical and dermoscopic features of ASTs, and their evolution over time.
METHODS
METHODS
This was a descriptive, multicentre study of the clinical and dermoscopic characteristics of ASTs. Data on clinical and dermoscopic characteristics, histopathology, local extension, therapy and follow-up, lymph node staging, complete lymph node dissection, and outcome were collected from the databases of four Italian Dermatology Units for the period 2004-2021.
RESULTS
RESULTS
The study population consisted of 99 patients (62 female, 37 male) with a histologically confirmed diagnosis of AST, including age at presentation ranged from 2 to 70 years (mean 28.1 years, median 24 years). Of the 99 patients, 29 (29.3%) underwent sentinel lymph node biopsy, which showed evidence of micrometastases in three cases (10.3%); all three patients underwent complete lymph node dissection with no evidence of further metastasis. Considering the whole study population, the clinical outcome was excellent, as all of the patients have no evidence of recurrence or distant metastasis. The follow-up period ranged from 6 to 216 months (mean 81.6 months, median 78 months). In addition, we collected data on the clinical and dermoscopic features of 26 lesions. The most frequent dermoscopic pattern observed was the multicomponent pattern (34.6%), followed by homogeneous (26.9%) and nonspecific (23.2%). In 66.7% of amelanotic ASTs, we observed glomerular (coiled) vessels uniformly distributed within the entire lesion, without asymmetry.
CONCLUSION
CONCLUSIONS
The results of our study with a long follow-up show no recurrence or distant metastases, confirming the good clinical outcome, even in the case of sentinel lymph node positivity. From a diagnostic point of view, our series identified a typical dermoscopic picture for amelanotic ASTs, with a glomerular vascular pattern throughout the lesion in the absence of other dermoscopic parameters, making the correct diagnosis possible.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1464-1471Informations de copyright
© 2022 British Association of Dermatologists.
Références
Spitz S. Melanomas of childhood. Am J Pathol 1948; 24: 591-609.
Elder DE, Bastian BC, Cree IA et al. The 2018 World Health Organization classification of cutaneous, mucosal, and uveal melanoma: detailed analysis of 9 distinct subtypes defined by their evolutionary pathway. Arch Pathol Lab Med 2020; 144: 500-22.
Harms KL, Lowe L, Fullen DR, Harms PW. Atypical Spitz tumors: a diagnostic challenge. Arch Pathol Lab Med 2015; 139: 1263-70.
Ludgate MW, Fullen DR, Lee J et al. The atypical Spitz tumor of uncertain biologic potential: a series of 67 patients from a single institution. Cancer 2009; 115: 631-41.
Moscarella E, Lallas A, Kyrgidis A et al. Clinical and dermoscopic features of atypical Spitz tumors: a multicenter, retrospective, case-control study. J Am Acad Dermatol 2015; 73: 777-84.
Menzies SW, Kreusch J, Byth K et al. Dermoscopic evaluation of amelanotic and hypomelanotic melanoma. Arch Dermatol 2008; 144: 1120-7.
Gerami P, Jewell SS, Morrison LE et al. Fluorescence in situ hybridization (FISH) as an ancillary diagnostic tool in the diagnosis of melanoma. Am J Surg Pathol 2009; 33: 1146-56.
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.
Lallas A, Kyrgidis A, Ferrara G et al. Atypical Spitz tumours and sentinel lymph node biopsy: a systematic review. Lancet Oncol 2014; 15: e178-83.
Massi D, Cesinaro AM, Tomasini C et al. Atypical Spitzoid melanocytic tumors: a morphological, mutational, and FISH analysis. J Am Acad Dermatol 2011; 64: 919-35.
Urso C, Borgognoni L, Doria M et al. Non-sentinel lymph node involvement in a patient with an atypical Spitz tumor and a positive sentinel node. Report of a case and review of the literature. J Cutan Pathol 2009; 36: 586-90.
Massi D, De Giorgi V, Mandalà M. The complex management of atypical Spitz tumours. Pathology 2016; 48: 132-41.
de la Fouchardiere A, Blokx W, van Kempen LC et al. ESP, EORTC, and EURACAN Expert Opinion: practical recommendations for the pathological diagnosis and clinical management of intermediate melanocytic tumors and rare related melanoma variants. Virchows Arch 2021; 479: 3-11.
Massi D, De Giorgi V, Soyer HP. Histopathologic correlates of dermoscopic criteria. Dermatol Clin 2001; 19: 259-68, vii.
de Giorgi V, Sestini S, Massi D et al. Dermoscopy for ‘true’ amelanotic melanoma: a clinical dermoscopic-pathologic case study. J Am Acad Dermatol 2006; 54: 341-4.
Zalaudek I, Di Stefani A, Argenziano G. The specific dermoscopic criteria of Bowen's disease. J Eur Acad Dermatol Venereol 2006; 20: 361-2.
Argenziano G, Zalaudek I, Corona R et al. Vascular structures in skin tumors: a dermoscopy study. Arch Dermatol 2004; 140: 1485-9.
de Giorgi V, Sestini S, Massi D et al. Atypical Spitz tumour: a ‘chameleon’ lesion. Clin Exp Dermatol 2008; 33: 309-11.
Lodha R, McDonald WS, Elgart GW, Thaller S. Dermoscopy for congenital melanocytic nevi. J Craniofac Surg 2003; 14: 661-5.