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Sentinel lymph node biopsy for patients with problematic spitzoid melanocytic lesions

A report on 18 patients

  1. Lyndon D. Su M.D.1,†,*,
  2. Douglas R. Fullen M.D.1,
  3. Vernon K. Sondak M.D.2,
  4. Timothy M. Johnson M.D.3,
  5. Lori Lowe M.D.1

Article first published online: 3 JAN 2003

DOI: 10.1002/cncr.11074

Issue

Cancer

Cancer

Volume 97, Issue 2, pages 499–507, 15 January 2003

Additional Information

How to Cite

Su, L. D., Fullen, D. R., Sondak, V. K., Johnson, T. M. and Lowe, L. (2003), Sentinel lymph node biopsy for patients with problematic spitzoid melanocytic lesions. Cancer, 97: 499–507. doi: 10.1002/cncr.11074

Author Information

  1. 1

    Department of Pathology and Dermatology, University of Michigan Medical Center, Ann Arbor, Michigan

  2. 2

    Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan

  3. 3

    Department of Dermatology, Otorhinolaryngology, and Surgery, University of Michigan Medical Center, Ann Arbor, Michigan

  1. †

    Fax: (734) 936-2756

*Department of Pathology, Division of Dermatopathology, University of Michigan Medical Center, Medical Sciences I, M5224, 1301 Catherine Street, Ann Arbor, MI 48109-0602

  1. †

    Fax: (734) 936-2756

Publication History

  1. Issue published online: 3 JAN 2003
  2. Article first published online: 3 JAN 2003
  3. Manuscript Accepted: 5 SEP 2002
  4. Manuscript Revised: 26 AUG 2002
  5. Manuscript Received: 19 JUN 2002

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Keywords:

  • Spitz nevus;
  • atypical Spitz tumor;
  • spitzoid melanoma;
  • sentinel lymph node

Abstract

BACKGROUND

Spindle and/or epithelioid melanocytic proliferations that display overlapping histopathologic features of Spitz nevus and Spitz-like melanoma are diagnostically difficult and controversial melanocytic tumors. There are reports of such lesions metastasizing to regional lymph nodes, with a few widely disseminating, resulting in death.

METHODS

The authors reviewed clinical and histopathologic data on all patients with atypical or borderline spitzoid melanocytic proliferations who underwent sentinel lymph node biopsy (SLNB). They examined how frequently histologically problematic or borderline spitzoid melanocytic lesions metastasized to sentinel lymph nodes (SLNs) and which clinical or histologic features, if any, predisposed patients to a higher risk lesion.

RESULTS

Six male patients and 12 female patients, ages 5–32 years (mean, 16 years), had tumors ranging in size from 1.2 mm to 7.9 mm (mean, 3.5 mm) in thickness. Atypical histologic features that were present most frequently included incomplete maturation (18 of 18 patients), deep dermal mitoses (16 of 18 patients), nuclear pleomorphism (10 of 18 patients), and focal sheet-like growth (10 of 18 patients). Eight of 18 patients (44%) had SLN metastasis and were offered adjuvant treatment. One of eight patients with SLN positive results who underwent regional lymphadenectomy had one additional involved lymph node. All 18 patients were alive and well with no evidence of recurrent or metastatic disease after a follow-up of 3–42 months (mean, 12 months).

CONCLUSIONS

Histologically atypical or borderline spitzoid, melanocytic tumors are diagnostically challenging and controversial melanocytic lesions, some of which represent unrecognized melanomas. SLNB aids in confirming a diagnosis of melanoma and identifies patients who may benefit from early therapeutic lymph node dissection and/or adjuvant therapy. Cancer 2003;97:499–507. © 2003 American Cancer Society.

DOI 10.1002/cncr.11074

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