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Australas J Dermatol 2022 May 5. Epub 2022 May 5.

Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.

Proliferative nodules (PNs) are benign nodular proliferation of melanocytes occurring within congenital melanocytic naevi (CMN). Differential diagnosis between PN and melanoma is challenging for clinicians and pathologists. We describe the case of a 9-month-old boy who developed multiple nodules arising in a medium-sized CMN. Read More

J Cutan Pathol 2022 Apr 30. Epub 2022 Apr 30.

Kaiser Permanente Los Angeles Medical Center, 4867 W. Sunset Boulevard, Los Angeles, CA, USA.

Background: Spitzoid melanocytic neoplasms are well known to be diagnostically challenging. Immunohistochemistry and molecular approaches have been used as ancillary diagnostic tests. Herein we investigate the use of PRAME immunohistochemistry (IHC) for the assessment of spitzoid melanocytic neoplasms. Read More

Int J Mol Sci 2022 Apr 11;23(8). Epub 2022 Apr 11.

Pathological Anatomy Unit, University Hospital of Padua, 35121 Padua, Italy.

Spitz neoplasms are a heterogeneous group of melanocytic proliferations with a great variability in the histological characteristics and in the biological behavior. Thanks to recent discoveries, the morpho-molecular landscape of Spitz lineage is becoming clearer, with the identification of subtypes with recurrent features thus providing the basis for a more solid and precise tumor classification. Indeed, specific mutually exclusive driver molecular events, namely or mutations, copy number gains of 11p, and fusions involving and genes, correlate with distinctive histological features. Read More

Am J Surg Pathol 2022 Mar 22. Epub 2022 Mar 22.

Cancer Research Center of Lyon, INSERM 1052, CNRS 5286, Lyon University, Claude Bernard Lyon 1 University Biopathology Department, Cancer-care Center Léon Bérard, Unicancer, Lyon CYPATH, Villeurbanne Department of Pathology, Aix Marseille University, INSERM, APHM MMG, UMR1251, Marmara Institute, Timone University Hospital, Marseille, France.

Pigmented epithelioid melanocytoma is a rare cutaneous melanocytic proliferation considered high-grade melanocytoma in the 2018 WHO Classification of Skin Tumors. Little has been reported about the associated genetic drivers in addition to BRAF and MAP2K1 mutations or PRKCA gene fusions. Here, we present a series of 21 cases of PRKAR1A-inactivated melanocytic tumors in which we could assess the associated genetic background. Read More

Am J Surg Pathol 2022 May;46(5):579-590

Department of Pathological Anatomy, Modena University Hospital, Modena, Italy.

PRAME (PReferentially expressed Antigen in MElanoma), a cancer testis antigen expressed in low levels in gonadal, endometrial, and adrenal gland tissues, has been recently considered a valuable tool in the differential diagnosis between benign and malignant melanocytic lesions. The aim of the current study is to perform PRAME immunostaining on a large series of benign and malignant acral lesions to evaluate the reproducibility of data reported in the literature and to validate PRAME as an affordable tool in the differential diagnosis between benign and malignant acral melanocytic tumors. Immunohistochemical analysis for PRAME was performed in 127 benign and malignant acral and nail melanocytic lesions. Read More

Clin Cosmet Investig Dermatol 2022 28;15:339-345. Epub 2022 Feb 28.

Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.

Spitz nevus (SN) is a benign melanocytic lesion with cytologic and architectural atypia. It is sometimes difficult to distinguish SNs from atypical Spitz tumor (AST), Spitz melanoma, or conventional melanoma. SNs frequently develop in Caucasians and appear on the skin of the head and lower extremities. Read More

Pediatr Dermatol 2022 Mar 21;39(2):220-225. Epub 2022 Feb 21.

Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.

Background/objectives: The principal environmental risk factor for conventional nevi and melanomas is ultraviolet exposure. However, little is known about genetic or environmental risk factors for developing Spitz tumors. This study investigates risk factors associated with Spitz neoplasms. Read More

Am J Dermatopathol 2022 May;44(5):355-359

Anatomic Pathology Unit, Santa Chiara Hospital, Trento, Italy.

Abstract: Spitz tumors are notoriously characterized by a high propensity to nodal involvement with a morphologically malignant (intraparenchymal) pattern but with little or no tendency toward further spread. We describe a case of spindle cell Spitz neoplasm removed from the thigh in a 34-year-old woman and initially diagnosed as "Spitzoid melanoma;" the sentinel node was characterized by a morphologically benign pattern of nodal involvement, with prevailingly capsular and septal aggregated of melanocytes showing the same cytomorphological features as the cutaneous tumor. Both the cutaneous and the nodal tumor were strongly ROS1-positive on immunohistochemistry; rearrangement of the ROS1 gene was confirmed with fluorescence in situ hybridization on the cutaneous tumor. Read More

Clin Exp Dermatol 2022 Feb 6. Epub 2022 Feb 6.

Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy.

Background: Atypical Spitz Tumors are regarded as an intermediate category distinguished from prototypical Spitz naevus by presenting one or more atypical features and often by an uncertain malignant potential. In this view, clinical and dermoscopic features may play a relevant role in the diagnostic approach.

Objectives: To evaluate the clinical and dermoscopic features of ASTs and their evolution over time. Read More

J Cutan Pathol 2022 Feb 3. Epub 2022 Feb 3.

Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.

ALK rearrangements define a histopathologically distinctive yet diverse subset of Spitz tumors characterized by fusiform to epithelioid melanocytes with frequent fascicular growth and ALK overexpression. Molecularly, these tumors are characterized by fusions between ALK and a variety of gene partners, most commonly TPM3 and DCTN1. We describe an unusual case of a Spitz nevus occurring in a 13-year-old female that manifested ALK immunopositivity with cell membrane localization. Read More

Eur J Cancer 2022 03 31;163:200-210. Epub 2022 Jan 31.

Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany; Dermatologie in Stuttgart, Stuttgart, Germany.

Background: Histological classification of atypical spitzoid tumours (ASTs) is unreliable, and categorisation of these lesions into benign and malignant is poorly reproducible. Here, we classified ASTs based on histology and chromosomal aberrations and explored the prognostic significance of genomic aberrations in a prospective cohort with a long-term follow-up.

Patients And Methods: Histologically equivocal ASTs from 76 patients were analysed by array comparative genomic hybridisation (aCGH). Read More

Ann Med 2022 Dec;54(1):244-252

Department of Plastic and General Surgery, Turku University Hospital and University of Turku, Turku, Finland.

Background: Changes in the incidence of melanoma in children and adolescents have been reported in Europe and in the USA in the recent decades.

Aims: The aim of this study was to examine the incidence of paediatric and adolescent melanomas in Finland in 1990-2014, and the associated clinical and histopathological characteristics to reveal temporal trends, such as changes in diagnostic sensitivity of Spitzoid melanomas.

Methods: Information on 122 patients diagnosed with cutaneous melanoma at 0-19 years of age in Finland in 1990-2014 were retrieved from the Finnish Cancer Registry. Read More

Histopathology 2022 Jan;80(1):122-134

Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Spitz tumours comprise a spectrum of melanocytic proliferations that share a set of distinct cytological features and molecular pathways. They include benign naevi, intermediate or indeterminate tumours and rare melanomas. Spitz tumours are notorious for the difficulty of distinguishing benign neoplasms with atypical features from melanomas and the related diagnostic uncertainty. Read More

Dermatopathology (Basel) 2021 Dec 1;8(4):525-530. Epub 2021 Dec 1.

Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari "Aldo Moro", 70124 Bari, Italy.

: SPARK nevus represents a little-known and characterized entity, with few case series available in the literature. : we present a case series of 12 patients (6 F and 6 M) between January 2005 and December 2020 and conduct a review of the current literature. Ten articles were selected on the basis of the adopted inclusion criteria and the PRISMA guidelines. Read More

Mod Pathol 2022 May 2;35(5):664-675. Epub 2021 Dec 2.

Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic.

BAP1-inactivated melanocytic tumor (BIMT) is a group of melanocytic neoplasms with epithelioid cell morphology molecularly characterized by the loss of function of BAP1, a tumor suppressor gene located on chromosome 3p21, and a mutually exclusive mitogenic driver mutation, more commonly BRAF. BIMTs can occur as a sporadic lesion or, less commonly, in the setting of an autosomal dominant cancer susceptibility syndrome caused by a BAP1 germline inactivating mutation. Owing to the frequent identification of remnants of a conventional nevus, BIMTs are currently classified within the group of combined melanocytic nevi. Read More

Int J Mol Sci 2021 Nov 15;22(22). Epub 2021 Nov 15.

Section of Anatomic Pathology, Department of Health Sciences, University of Florence, 50139 Florence, Italy.

Atypical Spitz tumors (AST) deviate from stereotypical Spitz nevi for one or more atypical features and are now regarded as an intermediate category of melanocytic tumors with uncertain malignant potential. Activating fusions elicit oncogenic events in Spitz lesions and are targetable with kinase inhibitors. However, their prevalence among ASTs and the optimal approach for their detection is yet to be determined. Read More

Hum Pathol 2022 02 18;120:9-17. Epub 2021 Nov 18.

Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China. Electronic address:

Preferentially expressed antigen in melanoma (PRAME) has shown promising utility in distinguishing benign melanocytic lesions from melanomas, but knowledge of its expression pattern in acral lentiginous melanoma (ALM) and acral nevi (ANs) is limited. Immunohistochemical expression of PRAME was examined in 75 ALMs and 34 ANs. The clinical and histopathologic characteristics of patients with ALM were collected. Read More

Am J Surg Pathol 2022 May;46(5):655-663

Departments of Biopathology.

Spitz neoplasms, according to 2018 WHO Blue Book, are morphologically defined by spindled and/or epithelioid melanocytes and genetically by either HRAS mutations or kinase gene fusions. The terminology "spitzoid" refers to lesions with similar morphology but with alternate or undefined genetic anomalies. Herein, we present 3 melanocytic neoplasms with a spitzoid cytomorphology, variable nuclear atypia, and harboring undescribed fusions involving RASGRF1. Read More

Dermatol Clin 2022 Jan 22;40(1):25-36. Epub 2021 Oct 22.

Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, Suite 200, Boston, MA 02114, USA; Dermatology Section, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA. Electronic address:

Patients are commonly referred to pediatric dermatology for the evaluation of pigmented lesions. For families, pediatricians, and dermatologists alike, malignancy is the main fear. In the past few decades, there has been evolving literature to inform diagnosis and management. Read More

Virchows Arch 2022 Feb 11;480(2):369-382. Epub 2021 Nov 11.

Department of Biopathology, Center Léon Bérard, Lyon, France.

Spitz nevi are indolent melanocytic tumors arising preferentially during and after childhood. Over the last decades, recurrent oncogenic drivers, sparsely detected in melanoma, were identified in Spitz melanocytic proliferations. Therefore, the detection of such drivers appears as a relevant diagnostic tool to distinguish both entities. Read More

Am J Surg Pathol 2021 12;45(12):1597-1605

Dermatopathology Consultations LLC, Lahey Clinic and Tufts MedicalSchool, Boston, MA.

Atypical Spitzoid melanocytic tumors are diagnostically challenging. Many studies have suggested various genomic markers to improve classification and prognostication. We aimed to assess whether next-generation sequencing studies using the Tempus xO assay assessing mutations in 1711 cancer-related genes and performing whole transcriptome mRNA sequencing for structural alterations could improve diagnostic agreement and accuracy in assessing neoplasms with Spitzoid histologic features. Read More

Am J Surg Pathol 2022 04;46(4):476-485

Department of Dermatology.

The current classification of Spitz neoplasms in the World Health Organization (WHO), Fourth Edition defines Spitz neoplasms as melanocytic proliferations with characteristic Spitz morphology and a Spitz-associated genomic fusion or HRAS mutation. In contrast, melanocytic neoplasms with BRAF mutations are considered typical of common acquired nevi, dysplastic nevi, and melanomas from intermittent sun-damaged skin. However, increased utilization of ancillary testing methods such as BRAFV600E immunohistochemistry and sequencing studies have made apparent a subgroup of benign-grade and intermediate-grade melanocytic neoplasms with Spitzoid morphology that harbor BRAFV600E mutations. Read More

Pediatr Dermatol 2021 Sep;38(5):1312-1314

Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Eur J Cancer 2021 11 24;157:514-515. Epub 2021 Sep 24.

Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany. Electronic address:

An Bras Dermatol 2021 Nov-Dec;96(6):768-770. Epub 2021 Sep 24.

Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address:

Eruptive disseminated Spitz nevi is a rare clinical presentation that features an abrupt widespread eruption of Spitz nevi. Spontaneous regression of these nevi has been rarely reported in previous literature. The authors of the present study report the case of a 30-year-old man who presented eruptive disseminated Spitz nevi that appeared within a week and started regression in the following years. Read More

Acta Dermatovenerol Alp Pannonica Adriat 2021 Sep;30(3):123-125

School of Medicine, St. George's University, St. George's, Grenada.

Spitz nevi in adults should be closely monitored. Dermoscopy is the preferred method of in vivo imaging of melanocytic nevi and may provide clues for high-risk lesions. However, there is not a perfect match between the dermoscopic image of an individual nevus, the evolution of its change, and its histopathology. Read More

Pediatr Dermatol 2021 Sep 24;38(5):1255-1257. Epub 2021 Sep 24.

Department of Dermatology, Mayo Clinic, Rochester, MN, USA.

Spitzoid melanocytic lesions describe a spectrum of pediatric melanocytic proliferations ranging from benign Spitz nevi to malignant spitzoid melanomas typically arising within the first two decades of life. Atypical spitzoid neoplasm (ASN) is a poorly defined category within this spectrum that poses a unique diagnostic challenge due to histologic findings with insufficient atypical characteristics to make the diagnosis of melanoma. This report presents an exceptionally rare case of an ulcerative atypical spitzoid neoplasm mimicking an infantile hemangioma in a two-month-old girl treated with pulse dyed laser (PDL) and surgical excision. Read More

Clin Plast Surg 2021 Oct 18;48(4):677-686. Epub 2021 Aug 18.

The Institute for Plastic Surgery, Department of Surgery, Southern Illinois University, 747 N. Rutledge Street, Springfield, IL 62704 USA. Electronic address:

The Spitz nevus is an uncommon melanocytic nevus. These lesions classically appear in childhood as a red, dome-shaped papule. They appear rarely in adults and may be pigmented. Read More

J Cutan Pathol 2022 Mar 20;49(3):220-230. Epub 2021 Sep 20.

Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA.

Acral melanocytic neoplasms often pose diagnostic difficulty. Preferentially expressed antigen in melanoma (PRAME) expression and loss of p16 expression have diagnostic utility in melanocytic tumors. We examined PRAME and p16 expression in 30 acral melanocytic neoplasms (n = 11 nevi; n = 2 dysplastic nevi; n = 7 Spitz nevi; n = 10 acral melanomas). Read More

Dermatopathology (Basel) 2021 Aug 1;8(3):301-314. Epub 2021 Aug 1.

Department of Biopathology, Center Léon Bérard, 69008 Lyon, France.

Cutaneous melanomas are exceptional in children and represent a variety of clinical situations, each with a different prognosis. In congenital nevi, the risk of transformation is correlated with the size of the nevus. The most frequent type is lateral transformation, extremely rare before puberty, reminiscent of a superficial spreading melanoma (SSM) ex-nevus. Read More