Standardized diagnostic algorithm for spitzoid lesions aids clinical decision-making and management: a case series from a Swiss reference center
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Marie-Luise Hilbers1, Regula Brändli2, Beda Mühleisen1, Sandra N. Freiberger3, Joanna Mangana1 and Reinhard Dummer1
1 Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
2 Department of Dermatopediatrics, Children’s Hospital Zurich, Zurich, Switzerland
3 Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
Keywords: spitzoid nevi; melanocytic lesion; dermatopathology; pediatric dermatology; diagnostic algorithm
Received: July 07, 2020 Accepted: December 14, 2020 Published: January 19, 2021
Importance: Spitzoid lesions are a group of melanocytic tumors characterized by spindle-like or epithelioid cells with variable malignant potential. While some spitzoid lesions are classified as evidently benign or malignant by clinic and histology, others present with unclear clinical and histological characteristics and are categorized as lesions of intermediate biologic potential. These lesions represent a challenge for pathologists and clinicians alike. No consensus on ancillary diagnostics and clinical management exists. Prediction of their clinical course is difficult. The implementation of ancillary diagnostics is currently subject of extensive discussions.
Observations: We report three cases of spitzoid lesions in three young female patients (3-, 15- and 17 years old) from a single reference center with different clinical and histological manifestations. In each case, uncertain clinical and histological presentation led to the stepwise application of additional diagnostics using immunohistochemistry and a custom next generation sequencing panel optimized for melanocytic lesions (MelArray). Combining ancillary diagnostics helped determine clinical management in all cases by characterizing the biology of these lesions.
Conclusions and Relevance: We illustrate how clinical, histological and molecular features contribute to an optimized management plan in these critical situations and present a possible algorithm for the assessment of spitzoid neoplasms.
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