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. 2017 Jan;44(1):5-14.
doi: 10.1111/cup.12826. Epub 2016 Oct 28.

The Utilization of Spitz-Related Nomenclature in the Histological Interpretation of Cutaneous Melanocytic Lesions by Practicing Pathologists: Results From the M-Path Study

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Free PMC article

The Utilization of Spitz-Related Nomenclature in the Histological Interpretation of Cutaneous Melanocytic Lesions by Practicing Pathologists: Results From the M-Path Study

Ge Zhao et al. J Cutan Pathol. .
Free PMC article

Abstract

Background: Spitz nevi, atypical Spitz tumors and spitzoid melanomas ('spitzoid lesions') represent controversial and poorly understood cutaneous melanocytic lesions that are difficult to diagnose histologically. It is unknown how these terms are used by pathologists.

Methods: We describe use of Spitz-related terminology using data from the Melanoma Pathology (M-Path) study database comprising pathologists' interpretations of biopsy slides, a nation-wide study evaluating practicing US pathologists' (N = 187) diagnoses of melanocytic lesions (8976 independent diagnostic assessments on 240 total test cases, with 1 slide per case).

Results: Most pathologists (90%) used the Spitz-related terminology. However, significant variation exists in which specific lesions were diagnosed as spitzoid and in the corresponding treatment recommendations. Recommendations ranged from 'no further treatment' to 'wide excision of 10 mm or greater' with no category capturing more than 50% of responses. For spitzoid melanoma diagnoses, 90% of pathologists recommended excision with ≥10 mm margin. Pathologists report less confidence in diagnosing these lesions compared with other melanocytic proliferations and are more likely to request second opinions and additional clinical information (all p < 0.05).

Conclusions: Spitzoid lesions are often not classified in any standardized way, evoke uncertainty in diagnosis by pathologists, and elicit variability in treatment recommendations.

Keywords: Spitz; dermatopathology; melanocytic nevus; melanoma; terminology.

Figures

Figure 1
Figure 1
Interpretations of Spitz nevus, atypical Spitz tumor, and spitzoid melanoma in each case with a least 4 Spitz-type assessments
Figure 2a
Figure 2a
Teaching case 1. 5x (top panel) and 20x (bottom panel)
Figure 2b
Figure 2b
Teaching case 2. 5x (top panel) and 20x (bottom panel)
Figure 2c
Figure 2c
Teaching case 3. 5x (top panel) and 20x (bottom panel)
Figure 2d
Figure 2d
Teaching case 4. 5x (top panel) and 20x (bottom panel)

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