Lack of significance of sentinel lymph node biopsy for the prognosis and management of the atypical Spitz tumor of uncertain biologic potential

• Published in: Expert review of dermatology Vol. 4; no. 3; pp. 215 - 217
• Main Authors: Alexandroff, Anton B, Da Forno, Philip D, Johnston, Graham A
• Format: Journal Article
• Language: English
• Published: London Informa Healthcare 01.06.2009; Taylor & Francis; Expert Reviews Ltd
• Subjects: ambiguous Spitzoid tumor; atypical Spitz tumor; Biopsy; Care and treatment; Diagnosis; Lymph nodes; Melanoma; Prognosis; sentinel lymph node biopsy; Spitz nevus; Spitz tumor; Spitzoid melanoma; Spitzoid tumor of uncertain malignant potential; STUMP; United Kingdom
• ISSN: 1746-9872; 1746-9880
• DOI: 10.1586/edm.09.15

Evaluation of: Ludgate MW, Fullen DR, Lee J et al. The atypical spitz tumor of uncertain biologic potential. A series of 67 patients from a single institution. Cancer 115, 631-641 (2009).Most Spitzoid melanocytic lesions can be identified histologically as either a benign Spitz nevus or malignant Spitzoid melanoma. However, a rare intermediate subset of Spitzoid proliferation exists that has overlapping histological features of both entities. Such equivocal lesions, which can be designated atypical Spitzoid tumors (ASTs) of uncertain biologic potential, are difficult to manage due to this unclear potency. Although patients with AST generally have a good prognosis, rarely these tumors can metastasize and become fatal. Consequently it has been suggested that all ASTs should be treated as melanomas, with a wide excision and a sentinel lymph node biopsy (SLNB). Although SLNB may still be utilized to improve prognosis, it is now recognized that it does not improve outcome in patients with melanomas. We review a recent paper by Ludgate et al., which studied a cohort of 67 patients with ASTs. Results from this paper suggest that ASTs do not behave like conventional melanomas and, in particular, positive SLNB is not associated with an adverse outcome. This important finding questions the use of SLNB in the management of ASTs.