THE UTILIZATION OF SPITZ-RELATED NOMENCLATURE IN THE HISTOLOGICAL INTERPRETATION OF CUTANEOUS MELANOCYTIC LESIONS BY PRACTICING PATHOLOGISTS

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 U.S. pathologists' (N = 187) diagnoses of melanocytic lesions (8,976 independent diagnostic assessments on 240 total test cases, with one 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.

http://ift.tt/2dgoTUE