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The utilization of spitz‐related nomenclature in the histological interpretation of cutaneous melanocytic lesions by practicing pathologists: results from the M‐Path study
Author(s) -
Zhao Ge,
Lee Kachiu C.,
Peacock Sue,
Reisch Lisa M.,
Knezevich Stevan R.,
Elder David E.,
Piepkorn Michael W.,
Elmore Joann G.,
Barnhill Raymond L.
Publication year - 2017
Publication title -
journal of cutaneous pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 75
eISSN - 1600-0560
pISSN - 0303-6987
DOI - 10.1111/cup.12826
Subject(s) - medicine , spitz nevus , dermatology , medical diagnosis , melanoma , pathology , terminology , nevus , anatomical pathology , biopsy , dermatopathology , immunohistochemistry , linguistics , philosophy , cancer research
Background Spitz nevi, atypical Spitz tumors and spitzoid melanomas (‘spitzoid lesions’) represent controversial and poorly understood cutaneous melanocytic lesions that are difficult to diagnose histologically. It is unknown how these terms are used by pathologists. Methods We describe use of Spitz‐related terminology using data from the Melanoma Pathology (M‐Path) study database comprising pathologists' interpretations of biopsy slides, a nation‐wide study evaluating practicing US pathologists' (N = 187) diagnoses of melanocytic lesions (8976 independent diagnostic assessments on 240 total test cases, with 1 slide per case). Results Most pathologists (90%) used the Spitz‐related terminology. However, significant variation exists in which specific lesions were diagnosed as spitzoid and in the corresponding treatment recommendations. Recommendations ranged from ‘no further treatment’ to ‘wide excision of 10 mm or greater’ with no category capturing more than 50% of responses. For spitzoid melanoma diagnoses, 90% of pathologists recommended excision with ≥10 mm margin. Pathologists report less confidence in diagnosing these lesions compared with other melanocytic proliferations and are more likely to request second opinions and additional clinical information (all p < 0.05). Conclusions Spitzoid lesions are often not classified in any standardized way, evoke uncertainty in diagnosis by pathologists, and elicit variability in treatment recommendations.