title: Atypical Spitz tumors in patients younger than 18 years.
abstract: BACKGROUND
  Diagnosis and proper management of atypical Spitz tumors in pediatric age are still controversial.
  
  
  OBJECTIVE
  We sought to investigate the clinicopathological and molecular features of atypical Spitz tumors in patients aged 18 years or younger.
  
  
  METHODS
  We performed a retrospective clinicopathological and fluorescence in situ hybridization study on 50 pediatric atypical Spitz tumors.
  
  
  RESULTS
  Parameters that were significantly correlated with a diagnosis of atypical Spitz tumors over Spitz nevus included asymmetry, level IV/V, lack of maturation, solid growth, nuclear pleomorphism, high nuclear-cytoplasmic ratio, atypical and deep mitoses, and more than 6 mitoses/mm(2). In the atypical Spitz tumors group, a significantly higher mitotic rate was observed in prepuberal age (P = .04). The 4-probe fluorescence in situ hybridization melanoma assay did not discriminate atypical Spitz tumors from Spitz nevi. Heterozygous 9p21 loss was found in 3 of 37 cases and homozygous 9p21 loss in 2 of 37 cases. Only 1 child experienced a fatal outcome, showing genetic abnormalities by melanoma fluorescence in situ hybridization probe and a heterozygous 9p21 deletion.
  
  
  CONCLUSIONS
  The limited number of adverse outcomes did not allow the prognostic analysis of single morphologic features.
  
  
  CONCLUSIONS
  Pediatric atypical Spitz tumors are associated with minimal lethal potential. Atypical Spitz tumors require complete excision and careful follow-up while our data do not support any clinical benefit for the sentinel lymph node biopsy procedure and completion lymphadenectomy.
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. Electronic address: daniela.massi@unifi.it.
authors.forename: Daniela
authors.initials: D
authors.lastname: Massi
authors.affiliation: Dermatopathology Section, Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Tomasini
authors.affiliation: Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Senetta
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Paglierani
authors.affiliation: Department of Biomedical, Experimental, and Clinical Sciences, University of Florence, Florence, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Salvianti
authors.affiliation: Pediatric Hospital Santobono-Pausilipon, Naples, Italy.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Errico
authors.affiliation: Pediatric Hospital Santobono-Pausilipon, Naples, Italy.
authors.forename: Vittoria
authors.initials: V
authors.lastname: Donofrio
authors.affiliation: Unit of Soft Tissue and Bone Pathology, Histopathology, and Pediatric Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Collini
authors.affiliation: Unit of Dermatopathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Gabrina
authors.initials: G
authors.lastname: Tragni
authors.affiliation: Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Angela Rita
authors.initials: AR
authors.lastname: Sementa
authors.affiliation: IRCSS AOU S. Martino, Department of Health Sciences, DISSAL, University of Genoa, Genoa, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Rongioletti
authors.affiliation: Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Renata
authors.initials: R
authors.lastname: Boldrini
authors.affiliation: Unit of Pediatric Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferrari
authors.affiliation: Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Gambini
authors.affiliation: Veneto Institute of Oncology Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico (IOV IRCCS), Padua, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Montesco
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D018332:Nevus, Epithelioid and Spindle Cell / Q000473:pathology*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*
keywords: Spitz nevus; atypical Spitz tumor; fluorescence in situ hybridization; pediatric age; sentinel lymph node