title: Long-term outcome of Spitz-type melanocytic tumors.
abstract: OBJECTIVE
  Despite recent advances in our molecular understanding of Spitz-type tumors, the clinical behavior of these lesions remains unclear. We thus set out to define the clinical outcome of classic Spitz nevi, atypical Spitz tumors (ASTs), and spitzoid melanomas.
  
  
  METHODS
  From 1987 through 2002, data on all lesions containing the term "Spitz" or "Spitz" [AND] "melanoma" were retrieved from the pathology database at Massachusetts General Hospital, and the cases were followed up for their outcome.
  
  
  METHODS
  The study was performed at a university-affiliated tertiary health care center in Boston, Massachusetts.
  
  
  METHODS
  A total of 157 patients with Spitz-type melanocytic lesions and follow-up information were identified.
  
  
  METHODS
  Sentinel lymph node biopsy results, metastases, or fatality were assessed.
  
  
  RESULTS
  There were 68 classic Spitz nevi, 76 ASTs, 10 spitzoid melanomas, and 3 melanomas that arose in Spitz nevi. Spitz nevi were diagnosed at a younger age than ASTs (mean age, 26.4 years vs 33.7 years) (P = .01), though both occurred earlier than melanomas (mean age, 50.4 years, P < .001). Sentinel lymph node biopsy findings were positive in 1 of 6 and 4 of 8 patients with ASTs and spitzoid melanomas, respectively. After a median follow-up of 9.1 years, only 1 patient with an AST, who had a separate intermediate-thickness melanoma, developed distant metastasis. There were 6 documented invasive melanomas among 144 patients with classic Spitz nevi or ASTs (observed/expected ratio, 8.03) (P = .01).
  
  
  CONCLUSIONS
  Atypical Spitz tumors are associated with minimal lethal potential, an increased melanoma risk, and a moderate risk of metastasis to regional nodes. It makes clinical sense to minimize aggressive treatment but to offer careful surveillance for rare relapses and subsequent melanomas.
authors.affiliation: Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Alireza
authors.initials: A
authors.lastname: Sepehr
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chao
authors.forename: Brie
authors.initials: B
authors.lastname: Trefrey
authors.forename: Amanda
authors.initials: A
authors.lastname: Blackford
authors.forename: Lyn McDivitt
authors.initials: LM
authors.lastname: Duncan
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Flotte
authors.forename: Arthur
authors.initials: A
authors.lastname: Sober
authors.forename: Martin C
authors.initials: MC
authors.lastname: Mihm
authors.forename: Hensin
authors.initials: H
authors.lastname: Tsao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001900:Boston / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008545:Melanoma / Q000453:epidemiology* / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D018332:Nevus, Epithelioid and Spindle Cell / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult