The Spitzoid lesion: rethinking Spitz tumors, atypical variants, ‘Spitzoid melanoma' and risk assessment

Abstract

Although much remains to be learned about Spitzoid lesions, there is increasing evidence that these tumors may be a type of melanocytic neoplasm distinct from conventional melanocytic nevi and malignant melanoma. In the current communication, the author has attempted to describe accurately the state-of-the-art surrounding these lesions, their nomenclature, and assessment of risk. Acknowledging the peculiar nature of Spitzoid lesions, the author prefers the term Spitz tumor rather than 'Spitz nevus' (except perhaps for the most typical lesions) and argues against using the term 'Spitzoid melanoma' until more information is available to justify such a term. The author also believes that patients are best served by the comprehensive evaluation of Spitzoid lesions and their classification into three categories: (1) Spitz tumor without significant abnormality, (2) Spitz tumor with one or more atypical features (atypical Spitz tumor), including those judged to have indeterminate biological potential, and (3) malignant melanoma, rather than the two categories of 'Spitz nevus' and melanoma. Only rigorous characterization of sufficient numbers of Spitzoid lesions and long-term follow-up of patients will provide truly objective information for the formulation of optimal guidelines for the management of patients with these lesions.

In Reply

“…We pointed out that this subgroup of tumors has a much more favorable prognosis than ''conventional'' melanomas and that the well-known, important prognosticators for conventional melanomas, such as tumor thickness and sentinel lymph node tumor-harboring status, do not appear to have the same significance for them. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] These facts support our proposal that such melanocytic tumors are biologically distinct and should be classified in a nosologic category separate from both melanomas and nevi.…”

Clinical and Biological Implications of the Tumor Microenvironment

“…Some of the glands have ragged partial investment with myoepithelial cells (broad arrow) and focal invasion of epithelial cells, bursting into the stroma through the gaps, can be seen (thin arrow). junctional nevi) and can sometimes be exuberant but orderly, as in a Spitz nevus [31], making interpretation complicated and difficult. In such melanotic lesions, the background clinical information including to the age of the patient, the number of pigmented lesions and their anatomical locations, as well as their macroscopic appearances are helpful in reaching decisions as to therapy.…”

Molecular histology on the diagnostic cutting edge between malignant melanomas and cutaneous melanocytomas (Review)

“…Using such an approach, most uncommon MM variants are also identified with confidence (9,17,19,32). It is acknowledged that MM molecular alterations and their respective immunological responses accompany the neoplastic progression from incipient to advanced stages (9,18).…”

“…Those neoplasms are tentatively classified in a spectrum going from 'benign' to 'not-so-benign', 'not-so-malignant', and 'malignant' (10). In the literature, the two intermediate categories are variously referred to as melanocytomas, melanocytic dysplasias, minimal deviation melanomas, borderline melanomas, melanocytic tumors of uncertain malignant potential (MELTUMP) and spitzoid melanocytic tumors of uncertain malignant potential (STUMP) (10,(14)(15)(16)(17)(18)(19)(20)(21)(22). Although conventional histology is the mainstay for diagnosing atypical melanocytic neoplasms, clinical features, in particular the dermoscopic aspects remain of central importance.…”