Ge Zhao1, Kachiu C Lee2, Sue Peacock3, Lisa M Reisch3, Stevan R Knezevich4, David E Elder5, Michael W Piepkorn6,7, Joann G Elmore3, Raymond L Barnhill8. 1. Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA, USA. 2. Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 3. Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. 4. Pathology Associates, Clovis, CA, USA. 5. Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 6. Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. 7. Dermatopathology Northwest, Bellevue, WA, USA. 8. Department of Pathology, Institut Curie, and Faculty of Medicine, University of Paris Descartes, Paris, France.
Abstract
BACKGROUND: Spitz nevi, atypical Spitz tumors and spitzoid melanomas ('spitzoid lesions') represent controversial and poorly understood cutaneous melanocytic lesions that are difficult to diagnose histologically. It is unknown how these terms are used by pathologists. METHODS: We describe use of Spitz-related terminology using data from the Melanoma Pathology (M-Path) study database comprising pathologists' interpretations of biopsy slides, a nation-wide study evaluating practicing US pathologists' (N = 187) diagnoses of melanocytic lesions (8976 independent diagnostic assessments on 240 total test cases, with 1 slide per case). RESULTS: Most pathologists (90%) used the Spitz-related terminology. However, significant variation exists in which specific lesions were diagnosed as spitzoid and in the corresponding treatment recommendations. Recommendations ranged from 'no further treatment' to 'wide excision of 10 mm or greater' with no category capturing more than 50% of responses. For spitzoid melanoma diagnoses, 90% of pathologists recommended excision with ≥10 mm margin. Pathologists report less confidence in diagnosing these lesions compared with other melanocytic proliferations and are more likely to request second opinions and additional clinical information (all p < 0.05). CONCLUSIONS: Spitzoid lesions are often not classified in any standardized way, evoke uncertainty in diagnosis by pathologists, and elicit variability in treatment recommendations.
BACKGROUND: Spitz nevi, atypical Spitz tumors and spitzoid melanomas ('spitzoid lesions') represent controversial and poorly understood cutaneous melanocytic lesions that are difficult to diagnose histologically. It is unknown how these terms are used by pathologists. METHODS: We describe use of Spitz-related terminology using data from the Melanoma Pathology (M-Path) study database comprising pathologists' interpretations of biopsy slides, a nation-wide study evaluating practicing US pathologists' (N = 187) diagnoses of melanocytic lesions (8976 independent diagnostic assessments on 240 total test cases, with 1 slide per case). RESULTS: Most pathologists (90%) used the Spitz-related terminology. However, significant variation exists in which specific lesions were diagnosed as spitzoid and in the corresponding treatment recommendations. Recommendations ranged from 'no further treatment' to 'wide excision of 10 mm or greater' with no category capturing more than 50% of responses. For spitzoid melanoma diagnoses, 90% of pathologists recommended excision with ≥10 mm margin. Pathologists report less confidence in diagnosing these lesions compared with other melanocytic proliferations and are more likely to request second opinions and additional clinical information (all p < 0.05). CONCLUSIONS:Spitzoid lesions are often not classified in any standardized way, evoke uncertainty in diagnosis by pathologists, and elicit variability in treatment recommendations.
Authors: Michael W Piepkorn; Raymond L Barnhill; David E Elder; Stevan R Knezevich; Patricia A Carney; Lisa M Reisch; Joann G Elmore Journal: J Am Acad Dermatol Date: 2013-10-28 Impact factor: 11.527
Authors: Lorenzo Cerroni; Raymond Barnhill; David Elder; Geoffrey Gottlieb; Peter Heenan; Heinz Kutzner; Philip E LeBoit; Martin Mihm; Juan Rosai; Helmut Kerl Journal: Am J Surg Pathol Date: 2010-03 Impact factor: 6.394
Authors: Iwei Yeh; Thomas Botton; Eric Talevich; A Hunter Shain; Alyssa J Sparatta; Arnaud de la Fouchardiere; Thaddeus W Mully; Jeffrey P North; Maria C Garrido; Alexander Gagnon; Swapna S Vemula; Timothy H McCalmont; Philip E LeBoit; Boris C Bastian Journal: Nat Commun Date: 2015-05-27 Impact factor: 14.919