HRAS-mutated Spitz tumors: A subtype of Spitz tumors with distinct features.
It is often very difficult to confidently distinguish benign and malignant Spitz lesions, and a diagnosis of Spitz tumor of unknown malignant potential (STUMP) is rendered. To address this problem, we performed molecular genetic analysis in a large group of Spitz tumors (93 Spitz nevi and 77 STUMPs) and identified a subgroup of 24 lesions harboring a HRAS mutation. This subgroup lay predominantly in the dermis, had a relatively low cellularity, showed desmoplasia (with single cells interspersed between the collagen bundles), and had an infiltrating base. In 7 of these 24 cases (29%) melanoma had been the initial diagnosis, or an important differential diagnostic consideration, mainly based on the presence of multiple or deeply located mitotic figures, especially in adult patients. In our series none of the patients with the HRAS-mutated lesions developed recurrences or metastases (mean and median follow-up: 10.5 y). This was in accordance with the literature: review showed that no HRAS mutations had so far been reported in Spitzoid melanomas. We therefore conclude that HRAS mutation analysis may be a useful diagnostic tool to help differentiate between Spitz nevus and Spitzoid melanoma, thereby reducing the frequency of overdiagnosis of melanoma, and to help predict the biological behavior of a STUMP. Moreover, this might be a first step toward a more reproducible classification of Spitz tumors combining histological and genetic data.
van Engen-van Grunsven
A C H
AC
Departments of Pathology, Radboud University Nijmegen Medical Center, The Netherlands. I.vanGrunsven@pathol.umcn.nl
van Dijk
Marcory C R F
MC
Ruiter
Dirk J
DJ
Klaasen
Annelies
A
Mooi
Wolter J
WJ
Blokx
Willeke A M
WA
D000293:Adolescent; D000328:Adult; D002648:Child; D004273:DNA, Neoplasm / Q000032:analysis; D020405:Dermis / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis; D008875:Middle Aged; D009154:Mutation; D018332:Nevus, Epithelioid and Spindle Cell / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D016283:Proto-Oncogene Proteins p21(ras) / Q000235:genetics*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
D004273:DNA, Neoplasm; C501009:HRAS protein, human; D016283:Proto-Oncogene Proteins p21(ras)