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Spitz Nevus Versus Spitzoid Melanoma: Diagnostic Difficulties, Conceptual Controversies

Mooi, Wolter J. MD*; Krausz, T. MD

Advances in Anatomic Pathology: July 2006 - Volume 13 - Issue 4 - p 147-156
Commentary
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The histologic distinction of Spitz nevus and Spitzoid melanoma is notoriously difficult, and an additional complication is provided by the fact that there may be a group of Spitz tumors that has the propensity to spread regionally, but not to distant sites.The interpretation of regional spread is subject of controversy. Mones and Ackerman regard it is as formal proof of malignancy, whereas others have argued that this stance constitutes an oversimplification. The ongoing controversy regarding the typing of “difficult” Spitz tumors with regional spread reflects these different viewpoints. We review the arguments that support the notion that regional spread cannot be equated with distant metastasis, and provide a critical commentary on Mones' and Ackerman's interpretation of their data and their review of the relevant literature.We advocate the use of 3 diagnostic categories: Spitz nevus, Spitzoid melanoma, and a provisional group of “Spitz tumor of uncertain malignant potential.” A discussion of the pros and cons of different terms and their usage concludes the article.

*Department of Pathology 3E43, VU medical centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands

Department of Pathology, The University of Chicago Hospitals, 5841 South Maryland Avenue, MC 6101 Chicago, IL

Reprints: Wolter J. Mooi, MD, Department of Pathology 3E43, VU medical centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands (e-mail: wj.mooi@vumc.nl).

© 2006 Lippincott Williams & Wilkins, Inc.