Atypical Spitzoid melanocytic tumors: A morphological, mutational, and FISH analysis

BackgroundIdentification of the clinical behavior of atypical Spitzoid tumors with conflicting histopathologic features remains controversial.ObjectiveWe sought to assess whether molecular findings may be helpful in the diagnostic and prognostic assessment of atypical Spitzoid tumors.MethodsA total of 38 controversial, atypical Spitzoid lesions (≥1 mm in thickness) were analyzed for clinicopathological features, chromosomal alterations by fluorescence in situ hybridization (FISH) analysis (RREB1/MYB/CCND1/CEP6), BRAFV600E mutation by allele-specific real-time polymerase chain reaction confirmed by sequencing, and H-RAS gene mutation by direct sequencing.ResultsAtypical Spitzoid lesions developed in 21 female and 17 male patients (mean age 22 years). Nine patients underwent sentinel lymph node biopsy and a sentinel lymph node micrometastasis was detected in 4 of these 9 cases. Four additional patients, who did not receive a sentinel lymph node biopsy, experienced bulky lymph node metastases and one experienced visceral metastases and death. Lesions from patients with lymph node involvement showed more deep mitoses (P < .01), less inflammation (P = .05), and more plasma cells (P = .04). FISH analysis demonstrated the presence of chromosomal alterations in 6 of 25 cases. Correlation with follow-up data showed that the only case with fatal outcome showed multiple chromosomal alterations by FISH analysis. BRAFV600E mutation was detected in 12 of 16 cases (75%) and H-RAS mutation on exon 3 was found in 3 of 11 cases (27%).LimitationsOur results require validation in a larger series with longer follow-up information.ConclusionsFISH assay may be of help in the prognostic evaluation of atypical Spitzoid tumors. Diagnostic significance of BRAFV600E and H-RAS mutations in this setting remains unclear.