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. 2019 Aug;181(2):366-372.
doi: 10.1111/bjd.17450. Epub 2019 Feb 10.

Clinical features and outcomes of spitzoid proliferations in children and adolescents

D W Bartenstein  1   2   3   4 , J M Fisher  1   4 , C Stamoulis  1   5 , C Weldon  1   6   7 , J T Huang  1   4   7 , S E Gellis  1   4 , M G Liang  1   4 , B Schmidt  1   8 , E B Hawryluk  1   2   4
Affiliations

Clinical features and outcomes of spitzoid proliferations in children and adolescents

D W Bartenstein et al. Br J Dermatol. 2019 Aug.

Abstract

Background: Spitzoid proliferations range from Spitz naevi to melanomas. There are few studies describing clinical features and outcomes in the paediatric population.

Objectives: To determine the clinical features and outcomes of a large paediatric cohort with histopathologically confirmed Spitz tumours.

Methods: This was a retrospective cohort study of patients seen at Boston Children's Hospital who were aged < 20 years and had a histopathological diagnosis of spitzoid proliferation from 1 January 1994 to 23 October 2012.

Results: In total 595 patients with 622 spitzoid proliferations were identified (median age 7·4 years, interquartile range 4·6-11·7). Overall 512 proliferations (82·3%) were typical, 107 (17·2.%) were atypical and three (0·5%) were melanomas. The median ages at biopsy were 7·4, 7·2 and 17·2 years, respectively, and there was a significant difference in age at biopsy for patients with typical or atypical proliferations vs. melanoma (P < 0·01). Among samples with positive margins (n = 153), 55% (54 of 98) of typical proliferations, 77% (41 of 53) of atypical proliferations and 100% (two of two) of melanomas were re-excised. Six patients had sentinel lymph node biopsy performed, with three patients demonstrating nodes positive for melanocytic cells. Within a median follow-up of 4·1 years for the full cohort there were no related deaths.

Conclusions: Spitz tumours have strikingly benign outcomes in the paediatric population, although this study is limited by the low number of melanomas and restriction to a single paediatric institution. Aggressive management recommendations should be reconsidered for children and adolescents with banal-appearing Spitz naevi, based on the clinically indolent behaviour in this cohort.

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Conflict of interest statement

EBH discloses non-relevant conflicts of interests: UpToDate, Inc (author, contributor), Foundation Medicine, Inc (stock), and Gritstone Oncology, Inc (spouse employment, stock).

Figures

Figure 1.
Figure 1.
Clinical, dermosocopic, pathologic, and genomic features of Spitzoid proliferations.
See this image and copyright information in PMC

Comment in

References

    1. Spitz S Melanomas of childhood. The American journal of pathology. 1948. May;24(3):591–609. PubMed PMID: 18859360. Pubmed Central PMCID: 1942798. - PMC - PubMed
    1. Wiesner T, Kutzner H, Cerroni L, Mihm MC Jr., Busam KJ, Murali R. Genomic aberrations in spitzoid melanocytic tumours and their implications for diagnosis, prognosis and therapy. Pathology. 2016. February;48(2):113–31. PubMed PMID: 27020384. Pubmed Central PMCID: 4817351. - PMC - PubMed
    1. R B, A B, BC B, KJ B, L C, A dlF, et al. Malignant Spitz tumour and Spitz Naevus In: DR E, D M, R S, R W, editors. WHO Classification of Skin Tumors, Fourth Edition. 4 ed: World Health Organization; 2018.
    1. Berk DR, LaBuz E, Dadras SS, Johnson DL, Swetter SM. Melanoma and melanocytic tumors of uncertain malignant potential in children, adolescents and young adults--the Stanford experience 1995–2008. Pediatric dermatology. 2010. May-Jun;27(3):244–54. PubMed PMID: 20403119. - PubMed
    1. Cerrato F, Wallins JS, Webb ML, McCarty ER, Schmidt BA, Labow BI. Outcomes in pediatric atypical spitz tumors treated without sentinel lymph node biopsy. Pediatric dermatology. 2012. Jul-Aug;29(4):448–53. PubMed PMID: 22211716. - PubMed

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