title: Deep penetrating nevus-like borderline tumors: A unique subset of ambiguous melanocytic tumors with malignant potential and normal cytogenetics.
abstract: BACKGROUND
  Deep penetrating nevi (DPN) are a relatively uncommon subtype of melanocytic nevi. A small subset of these lesions exhibit atypical features (cytologic and architectural atypia, mitotic activity) seen in melanoma. These lesions we term the deep penetrating nevus-like borderline tumor. Unequivocal melanomas can show overlapping morphologic features of DPN, which have been termed plexiform melanomas.
  
  
  METHODS
  40 cases of DPN-like borderline tumor were identified along with 6 cases of plexiform melanoma. Clinical follow up was obtained, along with cytogenetic analysis in the form of fluorescent in situ hybridization (FISH) and/or comparative genomic hybridization (CGH).
  
  
  RESULTS
  The DPN-like borderline tumor cases included 24 females and 16 males. Of sentinel lymph node biopsies performed, 1/3 of cases showed lymph node involvement. All patients where an aggressive clinical approach was adopted remain free of disease. All 6 DPN-like borderline tumor cases tested by CGH showed normal cytogenetics, as did 7 of 9 cases tested by FISH. Of the plexiform melanomas, 4/6 patients died of disease. In 3 cases there was morphologic progression from a DPN-like borderline tumor to overt melanoma. In one case of progression, cytogenetics was normal in the DPN-like borderline tumor and then abnormal in the progressed melanoma.
  
  
  CONCLUSIONS
  DPN-like borderline tumors are melanocytic tumors associated with a high incidence of regional lymph node disease and exhibiting the potential for melanoma progression despite a normal cytogenetic profile. Patients with these lesions should be aggressively managed, with at least complete re-excision and consideration of sentinel node biopsy, regardless of cytogenetic data.
authors.affiliation: Department of Pathology and Laboratory Medicine, Room F-309, 1300 York Avenue, Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Magro
authors.affiliation: Department of Pathology and Laboratory Medicine, Room F-309, 1300 York Avenue, Weill Medical College of Cornell University, New York, NY, USA, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, USA.
authors.forename: Ronnie M
authors.initials: RM
authors.lastname: Abraham
authors.affiliation: Department of Pathology.
authors.forename: Ruifeng
authors.initials: R
authors.lastname: Guo
authors.affiliation: Genetics Laboratory, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
authors.forename: Shibo
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Pathology and Laboratory Medicine, Room F-309, 1300 York Avenue, Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Xuan
authors.initials: X
authors.lastname: Wang
authors.affiliation: Center for Dermatology and Skin Surgery, Tampa, FL, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Proper
authors.affiliation: Regional Medical Laboratories, Tulsa, OK, USA.
authors.forename: A Neil
authors.initials: AN
authors.lastname: Crowson
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Mihm
mesh_terms: D000293:Adolescent; D000328:Adult; D002471:Cell Transformation, Neoplastic; D002648:Child; D002880:Chromosomes, Human, Pair 11; D002896:Chromosomes, Human, Pair 6; D055028:Comparative Genomic Hybridization; D019938:Cyclin D1 / Q000235:genetics; D004268:DNA-Binding Proteins / Q000235:genetics; D018450:Disease Progression; D005260:Female; D020570:Genes, myb / Q000235:genetics; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000235:genetics* / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000235:genetics* / Q000473:pathology* / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000235:genetics* / Q000473:pathology* / Q000601:surgery; D014157:Transcription Factors / Q000235:genetics; D055815:Young Adult
chemical_list: D004268:DNA-Binding Proteins; C101743:RREB1 protein, human; D014157:Transcription Factors; D019938:Cyclin D1
keywords: ambiguous melanocytic tumor; borderline melanocytic tumor; deep penetrating nevus; deep penetrating nevus-like borderline tumor; melanocytic tumor of uncertain malignant potential