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3.
Am J Dermatopathol ; 33(3): 236-43, 2011 May.
Article in English | MEDLINE | ID: mdl-21389834

ABSTRACT

Atypical spitzoid melanocytic neoplasms (ASMN) may prove difficult to distinguish microscopically from melanoma, and their biological behavior may be unpredictable. ASMN may result in regional lymph node (LN) metastases and frequent sentinel lymph node (SLN) deposits. Angiotropism and extravascular migratory metastasis may account for locoregional metastases in melanoma and thus may potentially explain such locoregional involvement in ASMN. Nine ASMN with angiotropism from 2006 to 2010 were studied. Angiotropism was defined as melanocytes closely opposed to the external surfaces of microvascular channels without intravasation. There were 5 women and 4 men aged 6-40 (mean 18.7) years with ASMN involving the head and neck (5), the extremities (3), and the trunk (1), and the lesions ranged in diameters from 3.5 to 10 (mean 6.2) mm. Breslow thicknesses ranged from 0.66 to 5.35 (mean 3.21) mm, 5 lesions Clark level IV and 4 level V, and dermal mitotic rates varied from 1 to 5 (mean 2.4) per square millimeter. Despite follow-up of 6 months or less in 4 subjects, 5 patients showed regional tumor spread based on detection of SLN deposits, local recurrence, or clinical satellite and LN metastases. Four of 5 patients (80%) undergoing SLN biopsy showed nodal positivity with 2 SLN deposits of >6 mm. Among 4 patients not having SLN biopsy, 1 patient developed local LN metastases after 2 years. We report for the first time angiotropism in ASMN and suggest that such angiotropism seems to correlate with and may explain regional tumor spread in this neoplastic system.


Subject(s)
Melanocytes/pathology , Neovascularization, Pathologic , Nevus, Epithelioid and Spindle Cell/pathology , Skin Neoplasms/pathology , Adolescent , Adult , Child , Female , Humans , Lymphatic Metastasis/pathology , Male , Neoplasm Invasiveness , Neoplasm Staging , Nevus, Epithelioid and Spindle Cell/blood supply , Sentinel Lymph Node Biopsy , Skin Neoplasms/blood supply , Young Adult
4.
J Cutan Pathol ; 36(4): 471-6, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19278435

ABSTRACT

Angiomatoid Spitz nevus is a recently described subtype of desmoplastic Spitz nevus. Six cases have been described in the literature thus far. Here, we describe six additional cases of angiomatoid Spitz nevus and provide a review of the literature on this entity. The features of classic angiomatoid Spitz nevus are described in the context of important differential diagnostic considerations, particularly regressed malignant melanoma.


Subject(s)
Nevus, Epithelioid and Spindle Cell/pathology , Skin Neoplasms/pathology , Adult , Child , Diagnosis, Differential , Female , Humans , Immunohistochemistry , Male , Melanoma/pathology , Nevus, Epithelioid and Spindle Cell/blood supply , Nevus, Epithelioid and Spindle Cell/metabolism , Skin Neoplasms/blood supply , Skin Neoplasms/metabolism
6.
Am J Dermatopathol ; 22(2): 135-9, 2000 Apr.
Article in English | MEDLINE | ID: mdl-10770433

ABSTRACT

Five cases of a distinctive variant of desmoplastic Spitz nevus are reported. To the best of our knowledge, this tumor has never been described previously. Clinically, it presents itself as a solitary papule on the extremities of young adults. Microscopically, it shows predominance of solitary melanocytes with epithelioid appearance over cell nests. They are embedded in a prominent fibrous stroma with many densely arranged, small blood vessels with plump endothelia not seen in other Spitz nevi. Because of its resemblance to a vascular tumor, the name angiomatoid Spitz nevus is proposed for this lesion. Absence of recurrences or metastases after complete excision in all cases supports the benign nature of the tumor.


Subject(s)
Neovascularization, Pathologic/pathology , Nevus, Epithelioid and Spindle Cell/pathology , Skin Neoplasms/pathology , Adult , Biomarkers, Tumor/analysis , Female , Follow-Up Studies , Humans , Immunoenzyme Techniques , Melanocytes/pathology , Nevus, Epithelioid and Spindle Cell/blood supply , Nevus, Epithelioid and Spindle Cell/chemistry , Nevus, Epithelioid and Spindle Cell/surgery , Skin Neoplasms/blood supply , Skin Neoplasms/chemistry , Skin Neoplasms/surgery
7.
Am J Pathol ; 145(3): 510-4, 1994 Sep.
Article in English | MEDLINE | ID: mdl-7521576

ABSTRACT

Angiogenesis in malignant melanoma (MM) was evaluated by comparing mean vessel number (MVN) in Spitz's nevi (SN), thick and thin MMs that metastasized, and thick and thin MMs with > or = 10-year survival. Vessels were identified with antibodies against factor VIII-related antigen (FVIII) and CD34 in 37 MMs (17 < or = 1.9 mm and 20 > or = 4.0 mm) with > or = 10-year follow-up and 10 SN from children (< or = 9 years old). Fields (x250) with the highest vessel density were counted by independent observers blinded to clinical outcome. There were no differences in MVN between SN versus MMs (P = 1.0), but the distribution of vessels was much more uniform in SN. Seven MM pairs (> or = 5.5 mm) and five pairs (< or = 0.75 mm) were matched by sex, age, site, stage, and primary treatment (paired t-test). In the pairs > or = 5.5 mm, there was no correlation with MVN with either metastasis or death (FVIII P = 0.98; CD34 P = 0.85). Among the thin paired lesions, high MVN (FVIII = 46, CD34 = 39) was significantly related not only to metastasis (FVIII P = 0.04, CD34 P = 0.03) but also to death (FVIII P = 0.04, CD34 P = 0.05). MVN does not separate SN versus MM nor predict outcome in thick (> or = 4.0 mm) MMs; however, high MVN (> or = 42 average) is predictive of metastasis and death in MMs < or = 0.75 mm. Larger matched studies are indicated to confirm this observation.


Subject(s)
Melanoma/blood supply , Skin Neoplasms/blood supply , Adult , Aged , Antigens, CD/analysis , Antigens, CD34 , Child , Follow-Up Studies , Humans , Melanoma/mortality , Melanoma/secondary , Middle Aged , Nevus, Epithelioid and Spindle Cell/blood supply , Prognosis , Skin Neoplasms/mortality , Skin Neoplasms/pathology , von Willebrand Factor/analysis
8.
Am J Dermatopathol ; 16(1): 9-13, 1994 Feb.
Article in English | MEDLINE | ID: mdl-7512803

ABSTRACT

Spitz nevus is a well-known histologic simulator of malignant melanoma. Vascularity of human neoplasms has been associated with prognosis as well as propensity for metastasis. Were vascularity significantly different between melanoma and Spitz nevus, it could serve as a feature to distinguish between these two neoplasms. We evaluated the vascularity of a series of primary cutaneous melanomas ranging from thin superficial spreading to nodular lesions as well as superficial compound and nodular deep Spitz nevi by using light-microscopic evaluation of factor-VIII-stained sections. Vascularity was density graded and microvessels were counted per x200 and x400 field. Vascular density and microvessel counts were significantly different between melanomas of 2+ and 3+ vascularity compared with all types of Spitz nevi. Although nodular malignant melanomata tended to have a greater degree of vascularity than thin melanomas, there was a significant population of both of these subtypes having few or many vessels. We conclude that the number of microvessels per x200 and x400 field in areas of greatest vascularity is significantly less in Spitz nevus than in malignant melanoma. There is a subset of melanoma, however, in which the number of microvessels may be low. Nodular melanomata tended to have a greater number of vessels than did thin superficial spreading lesions. Evaluation of microvessel count may be of assistance when coupled with clinical and histologic findings in distinguishing between melanoma and Spitz nevus in selected cases.


Subject(s)
Melanoma/blood supply , Neovascularization, Pathologic/pathology , Nevus, Epithelioid and Spindle Cell/blood supply , Skin Neoplasms/blood supply , Skin/blood supply , Blood Vessels/pathology , Endothelium, Vascular/pathology , Epidermis/pathology , Factor VIII/analysis , Humans , Immunoenzyme Techniques , Melanoma/pathology , Nevus, Epithelioid and Spindle Cell/pathology , Skin Neoplasms/pathology , Staining and Labeling
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