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10.1245/s10434-007-9577-3
Annals of Surgical Oncology 15:302-309 (2008)
© 2008 Society of Surgical Oncology
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Original Article

Sentinel Lymph Node Biopsy in Histologically Ambiguous Melanocytic Tumors With Spitzoid Features (So-Called Atypical Spitzoid Tumors)

Rajmohan Murali, MBBS, FRCPA1,2,3,6, Raghwa N. Sharma, MBBS, FRCPA4, John F. Thompson, MD, FRACS, FACS1,2,5, Jonathan R. Stretch, MBBS, DPhil, FRACS1,2,5, C. Soon Lee, MD, FRCPA, FRCPath3,6, Stanley W. McCarthy, MBBS, FRCPA2,3,6 and Richard A. Scolyer, MD, FRCPA, FRCPath1,2,3,6

1 Sydney Melanoma Unit, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia
2 Melanoma and Skin Cancer Research Institute, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia
3 Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia
4 Department of Anatomical Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia
5 Discipline of Surgery, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
6 Discipline of Pathology, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia

Correspondence: Address correspondence and reprint requests to: John F. Thompson, MD, FRACS, FACS; E-mail: john. thompson{at}smu.org.au

Background: The distinction of Spitz nevi from melanomas with spitzoid morphology can be difficult. For lesions with overlapping histopathologic features, it may be impossible to predict their malignant potential with certainty. The current study evaluated the role of sentinel lymph node (SLN) biopsy in patients with such atypical spitzoid tumors.

Methods: The clinical and histopathologic features of 21 patients with atypical spitzoid tumors who underwent SLN biopsy were reviewed and correlated with the presence or absence of metastatic tumor in their corresponding SLNs.

Results: The atypical histopathologic features that were most frequently present included incomplete maturation (11 patients, 52%), two or more dermal mitoses per square millimeter (13 patients, 62%), and deep dermal mitoses (11 patients, 52%). Six patients (29%) showed SLN metastasis. There were histopathologic differences between tumors with positive SLN when compared with tumors with negative SLN: mean tumor thickness (3.38 mm vs. 2.04 mm), incomplete maturation (83% vs. 40%), median dermal mitotic rate (3.5/mm2 vs. 2/mm2), deep dermal mitoses (83% vs. 47%), and expansile dermal nodules (50% vs. 13%). However, of these, only the difference in mean tumor thickness reached statistical significance (P < .05).

Conclusions: SLN biopsy offers a means of assessing the metastatic potential of atypical spitzoid tumors and aids in the management of these patients by selecting patients who may benefit from a regional node field dissection and those in whom the use of adjuvant therapies could be considered.

Key Words: Sentinel lymph node • Spitz nevus • Melanoma • Clinical • Histopathology






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