TY - JOUR
T1 - Long-term outcome of spitz-type melanocytic tumors
AU - Sepehr, Alireza
AU - Chao, Elizabeth
AU - Trefrey, Brie
AU - Blackford, Amanda
AU - Duncan, Lyn Mc Divitt
AU - Flotte, Thomas J.
AU - Sober, Arthur
AU - Mihm, Martin C.
AU - Tsao, Hensin
PY - 2011/10
Y1 - 2011/10
N2 - Objective: Despite recent advances in our molecular understanding of Spitz-type tumors, the clinical behavior of these lesions remains unclear. We thus set out to define the clinical outcome of classic Spitz nevi, atypical Spitz tumors (ASTs), and spitzoid melanomas. Design: From 1987 through 2002, data on all lesions containing the term "Spitz" or "Spitz" [AND] "melanoma" were retrieved from the pathology database at Massachusetts General Hospital, and the cases were followed up for their outcome. Setting: Thestudywasperformed at a university-affiliated tertiary health care center in Boston, Massachusetts. Patients: A total of 157 patients with Spitz-type melanocytic lesions and follow-up information were identified. Main Outcome Measures: Sentinel lymph node biopsy results, metastases, or fatality were assessed. Results: There were 68 classic Spitz nevi, 76 ASTs, 10 spitzoid melanomas, and 3 melanomas that arose in Spitz nevi. Spitz nevi were diagnosed at a younger age than ASTs (mean age, 26.4 years vs 33.7 years) (P=.01), though both occurred earlier than melanomas (mean age, 50.4 years, P<.001). Sentinel lymph node biopsy findings were positive in 1 of 6 and 4 of 8 patients with ASTs and spitzoid melanomas, respectively. After a median follow-up of 9.1 years, only 1 patient with an AST, who had a separate intermediate-thickness melanoma, developed distant metastasis. There were 6 documented invasive melanomas among 144 patients with classic Spitz nevi or ASTs (observed/ expected ratio, 8.03) (P=.01). Conclusions: Atypical Spitz tumors are associated with minimal lethal potential, an increased melanoma risk, and a moderate risk of metastasis to regional nodes. It makes clinical sense to minimize aggressive treatment but to offer careful surveillance for rare relapses and subsequent melanomas.
AB - Objective: Despite recent advances in our molecular understanding of Spitz-type tumors, the clinical behavior of these lesions remains unclear. We thus set out to define the clinical outcome of classic Spitz nevi, atypical Spitz tumors (ASTs), and spitzoid melanomas. Design: From 1987 through 2002, data on all lesions containing the term "Spitz" or "Spitz" [AND] "melanoma" were retrieved from the pathology database at Massachusetts General Hospital, and the cases were followed up for their outcome. Setting: Thestudywasperformed at a university-affiliated tertiary health care center in Boston, Massachusetts. Patients: A total of 157 patients with Spitz-type melanocytic lesions and follow-up information were identified. Main Outcome Measures: Sentinel lymph node biopsy results, metastases, or fatality were assessed. Results: There were 68 classic Spitz nevi, 76 ASTs, 10 spitzoid melanomas, and 3 melanomas that arose in Spitz nevi. Spitz nevi were diagnosed at a younger age than ASTs (mean age, 26.4 years vs 33.7 years) (P=.01), though both occurred earlier than melanomas (mean age, 50.4 years, P<.001). Sentinel lymph node biopsy findings were positive in 1 of 6 and 4 of 8 patients with ASTs and spitzoid melanomas, respectively. After a median follow-up of 9.1 years, only 1 patient with an AST, who had a separate intermediate-thickness melanoma, developed distant metastasis. There were 6 documented invasive melanomas among 144 patients with classic Spitz nevi or ASTs (observed/ expected ratio, 8.03) (P=.01). Conclusions: Atypical Spitz tumors are associated with minimal lethal potential, an increased melanoma risk, and a moderate risk of metastasis to regional nodes. It makes clinical sense to minimize aggressive treatment but to offer careful surveillance for rare relapses and subsequent melanomas.
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U2 - 10.1001/archdermatol.2011.170
DO - 10.1001/archdermatol.2011.170
M3 - Article
C2 - 21680758
AN - SCOPUS:80054772259
SN - 0003-987X
VL - 147
SP - 1173
EP - 1179
JO - Archives of Dermatology
JF - Archives of Dermatology
IS - 10
ER -