title: Atypical spitzoid melanocytic tumors with positive sentinel lymph nodes in children and teenagers, and comparison with histologically unambiguous and lethal melanomas.
abstract: Children and teenagers with a positive sentinel lymph node (SLN) after a prior diagnosis of an atypical spitzoid melanocytic tumor (ASMT) are usually cared for clinically in the same way as patients with melanoma. Little is known about long-term follow-up of these individuals to determine whether this practice is appropriate. To learn more about the biology of these tumors we retrospectively reviewed the clinical and pathologic findings of children and teenagers (<18 y of age at the time of diagnosis) with an ASMT, positive SLN and follow-up of at least 3 years. Their findings were compared with histologically unambiguous melanomas of children or teenagers, who had a positive SLN or died of metastatic melanoma. Eleven individuals, 6 girls and 5 boys, with primary ASMT and positive SLN were identified. The primary tumors ranged in thickness from 2.1 to 12 mm (median, 4.6 mm; mean, 5 mm). The tumor mitotic rate ranged from 1 to 10 mitoses/mm (median, 3/mm, median, 3/mm). The positive SLNs included 6 nodes with intranodal melanocytic aggregates measuring <1 mm in greatest dimension, and 5 nodes, in which the size of the melanocyte deposits was >/=1 mm. All the patients with ASMT and positive SLN remained free of disease with a median follow-up of 47 months (mean, 61 mo, range: 36 to 132 mo). In contrast, 2 of 5 patients <18 years of age with a histologically unambiguous melanoma and a positive SLN died of metastatic melanoma. The overall disease-specific mortality rate for all patients <18 years of age diagnosed with melanoma was 12%. Our findings confirm that children and teenagers with ASMTs and positive SLNs have a less aggressive clinical course than those with histologically unambiguous melanoma.
authors.affiliation: Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. busamk@mskcc.org
authors.forename: Klaus J
authors.initials: KJ
authors.lastname: Busam
authors.forename: Rajmohan
authors.initials: R
authors.lastname: Murali
authors.forename: Melissa
authors.initials: M
authors.lastname: Pulitzer
authors.forename: Stanley W
authors.initials: SW
authors.lastname: McCarthy
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
authors.forename: Helen M
authors.initials: HM
authors.lastname: Shaw
authors.forename: Mary S
authors.initials: MS
authors.lastname: Brady
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Coit
authors.forename: Stephen
authors.initials: S
authors.lastname: Dusza
authors.forename: James
authors.initials: J
authors.lastname: Wilmott
authors.forename: Marc
authors.initials: M
authors.lastname: Kayton
authors.forename: Michael
authors.initials: M
authors.lastname: Laquaglia
authors.forename: Richard A
authors.initials: RA
authors.lastname: Scolyer
mesh_terms: D000293:Adolescent; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000556:secondary* / Q000601:surgery; D018332:Nevus, Epithelioid and Spindle Cell / Q000473:pathology* / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery