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Atypical Spitz Tumors With 6q23 Deletions: A Clinical, Histological, and Molecular Study

Shen, Lisa MD*; Cooper, Chelsea BA*; Bajaj, Shirin BA*; Liu, Ping PhD; Pestova, Ekaterina PhD; Guitart, Joan MD*,‡; Gerami, Pedram MD*,‡

The American Journal of Dermatopathology: December 2013 - Volume 35 - Issue 8 - p 804–812
doi: 10.1097/DAD.0b013e31828671bf
Original Study

Abstract: Determining risk assessment for aggressive behavior of atypical Spitz tumors (ASTs) remains a significant challenge for pathologists. Despite the presence of many concerning histological features such as tumor ulceration, expansile growth, dermal mitotic rate, and cytological atypia, the overwhelming majority of these tumors behave in an indolent fashion. Recently, we have noted that using cytogenetics, one can identify ASTs with high likelihood for aggressive behavior allowing for a clinically significant risk assessment. In this retrospective case-controlled study, we examined the clinical and histological features of 24 cases of ASTs that were found to have isolated copy number deletions in 6q23 when studied by probes targeting 6p25, 6q23, Cep6, 11q13, 9p21, and Cep9. Although 6 of 11 patients had a positive sentinel node biopsy, none of the patients developed tumor in a nonsentinel node, palpable adenopathy, in transit metastasis, or distant metastasis. Histopathologically, the tumors showed minimal pagetoid spread (P = 0.004) and trended toward a histological presentation with expansile nodular growth (P = 0.08) and focal ulceration (P = 0.19). Furthermore, we also depict and illustrate the challenges that may occur in accurately identifying 6q23 deletions using fluorescence in situ hybridization in ASTs.

*Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL;

Abbott Molecular Laboratories, Des Plaines, IL; and

Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL.

Reprints: Pedram Gerami, MD, Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N St Clair Street, Suite 1600, Chicago, IL 60611 (e-mail:

Supported in part by Abbott Molecular.

Dr P. Gerami has served as a consultant to Abbott Molecular Labs, Myriad Genomics, and Neogenomics and has received honoraria for this. The other authors declare no conflicts of interest.

L. Shen and C. Cooper have contributed equally.

© 2013 by Lippincott Williams & Wilkins.