Spitz Tumors With ROS1 Fusions: A Clinicopathological Study of 6 Cases, Including FISH for Chromosomal Copy Number Alterations and Mutation Analysis Using Next-Generation Sequencing

Am J Dermatopathol. 2020 Feb;42(2):92-102. doi: 10.1097/DAD.0000000000001499.


Spitz tumors represent a heterogeneous group of melanocytic neoplasms with a spectrum of biological behavior ranging from benign (Spitz nevus) to malignant (spitzoid melanoma). Prediction of the behavior of these lesions based on their histological presentation is not always possible. Recently, mutually exclusive activating kinase fusions, involving ALK, NTRK1, NTRK3, RET, MET, ROS1, and BRAF, have been found in a subset of spitzoid lesions. Some of these genetic alterations were associated with specific morphological features. Here, we report the histological presentation of 6 Spitz tumors with ROS1 fusion. The age of the patients ranged from 6 to 34 years, with strong female prevalence (5:1). All neoplasms were compound melanocytic proliferations with a predominant dermal growth but a conspicuous junctional component displaying atypical microscopic features qualifying them as atypical Spitz tumor. FIP1L1 and CAPRIN1 were identified as 2 novel 5'-fusion partners of ROS1 along with the known PWWP2A-ROS1 fusion. FISH for copy number changes of 9p21, 6p25, and 11q13 was negative in all but 1 neoplasm harboring isolated gain of 8q24. TERT-promoter hotspot mutation analysis was negative in all tumors. All patients are disease-free after a mean follow-up period of 30 months. It is concluded that ROS1-fused spitzoid neoplasms seem to have no distinctive histopathological features although consistent findings were spindled melanocytes arranged in confluent whorling nests, prominent transepidermal elimination of melanocytic nests, and myxoid/mucinous changes.

MeSH terms

  • Adolescent
  • Adult
  • Cell Cycle Proteins / genetics
  • Child
  • Chromosomal Proteins, Non-Histone / genetics
  • DNA Copy Number Variations
  • DNA Mutational Analysis
  • Female
  • High-Throughput Nucleotide Sequencing
  • Humans
  • In Situ Hybridization, Fluorescence
  • Male
  • Melanoma / genetics*
  • Melanoma / pathology
  • Nevus, Epithelioid and Spindle Cell / genetics*
  • Nevus, Epithelioid and Spindle Cell / pathology
  • Oncogene Fusion
  • Protein-Tyrosine Kinases / genetics*
  • Proto-Oncogene Proteins / genetics*
  • Skin Neoplasms / genetics*
  • Skin Neoplasms / pathology
  • Telomerase / genetics
  • Young Adult
  • mRNA Cleavage and Polyadenylation Factors / genetics


  • CAPRIN1 protein, human
  • Cell Cycle Proteins
  • Chromosomal Proteins, Non-Histone
  • FIP1L1 protein, human
  • PWWP2A protein, human
  • Proto-Oncogene Proteins
  • mRNA Cleavage and Polyadenylation Factors
  • Protein-Tyrosine Kinases
  • ROS1 protein, human
  • TERT protein, human
  • Telomerase