Abstract
Importance: Spitzoid lesions are a group of melanocytic tumors characterized by spindle-like or epithelioid cells with variable malignant potential. While some spitzoid lesions are classified as evidently benign or malignant by clinic and histology, others present with unclear clinical and histological characteristics and are categorized as lesions of intermediate biologic potential. These lesions represent a challenge for pathologists and clinicians alike. No consensus on ancillary diagnostics and clinical management exists. Prediction of their clinical course is difficult. The implementation of ancillary diagnostics is currently subject of extensive discussions.Observations: We report three cases of spitzoid lesions in three young female patients (3-, 15- and 17 years old) from a single reference center with different clinical and histological manifestations. In each case, uncertain clinical and histological presentation led to the stepwise application of additional diagnostics using immunohistochemistry and a custom next generation sequencing panel optimized for melanocytic lesions (MelArray). Combining ancillary diagnostics helped determine clinical management in all cases by characterizing the biology of these lesions.Conclusions and Relevance: We illustrate how clinical, histological and molecular features contribute to an optimized management plan in these critical situations and present a possible algorithm for the assessment of spitzoid neoplasms.
Highlights
Spitzoid lesions are a diverse group of rapidgrowing melanocytic tumors characterized by spindlelike or epithelioid cells
We illustrate how clinical, histological and molecular features contribute to an optimized management plan in these critical situations and present a possible algorithm for the assessment of spitzoid neoplasms
Certain spitzoid lesions show benign or malignant clinic and histology, while others present with unclear characteristics and are categorized as lesions of intermediate biologic potential [1]
Summary
Spitzoid lesions are a diverse group of rapidgrowing melanocytic tumors characterized by spindlelike or epithelioid cells. Certain spitzoid lesions show benign or malignant clinic and histology, while others present with unclear characteristics and are categorized as lesions of intermediate biologic potential [1] These lesions are a challenge for pathologists and clinicians, as there is no consensus on ancillary diagnostics or clinical management [2]. IHC and MelArray were performed (see Figure 2) Based on this diagnostic constellation, a re-excision with 1 cm safety margin was carried out shortly after. The clinical management followed current melanoma guidelines: a re-excision with 2 cm safety margin and sentinel lymph node biopsy (SLNB) were performed. Follow-ups took place every 3 months and showed no recurrence until February 2019, when multiple lymph node, lung and brain metastases were detected during routine diagnostics. The last PET/CT performed in December 2019 showed complete response of all extracranial lesions and cMRI showed stable disease
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