The Spitzoid lesion: rethinking Spitz tumors, atypical variants, 'Spitzoid melanoma' and risk assessment.
Although much remains to be learned about Spitzoid lesions, there is increasing evidence that these tumors may be a type of melanocytic neoplasm distinct from conventional melanocytic nevi and malignant melanoma. In the current communication, the author has attempted to describe accurately the state-of-the-art surrounding these lesions, their nomenclature, and assessment of risk. Acknowledging the peculiar nature of Spitzoid lesions, the author prefers the term Spitz tumor rather than 'Spitz nevus' (except perhaps for the most typical lesions) and argues against using the term 'Spitzoid melanoma' until more information is available to justify such a term. The author also believes that patients are best served by the comprehensive evaluation of Spitzoid lesions and their classification into three categories: (1) Spitz tumor without significant abnormality, (2) Spitz tumor with one or more atypical features (atypical Spitz tumor), including those judged to have indeterminate biological potential, and (3) malignant melanoma, rather than the two categories of 'Spitz nevus' and melanoma. Only rigorous characterization of sufficient numbers of Spitzoid lesions and long-term follow-up of patients will provide truly objective information for the formulation of optimal guidelines for the management of patients with these lesions.
Barnhill
Raymond L
RL
Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL 33104, USA. rbarnhill@mad.miami.edu
D003937:Diagnosis, Differential; D011905:Genes, ras / Q000235:genetics; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000032:analysis; D008545:Melanoma / Q000235:genetics / Q000378:metabolism / Q000473:pathology; D009154:Mutation; D009362:Neoplasm Metastasis; D018332:Nevus, Epithelioid and Spindle Cell / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics; D018570:Risk Assessment; D009418:S100 Proteins / Q000032:analysis; D012878:Skin Neoplasms / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D009626:Terminology as Topic
D019394:Ki-67 Antigen; D009418:S100 Proteins; D048493:Proto-Oncogene Proteins B-raf