Urso Carmelo
Department of Anatomic Pathology, Dermatopathology Section, SM Annunziata Hospital, AUSL Toscana Centro, Florence, Italy.
Dermatol Pract Concept. 2016 Apr 30;6(2):43-8. doi: 10.5826/dpc.0602a08. eCollection 2016 Apr.
Spitzoid neoplasms may pose significant diagnostic problems because in a fraction of them it is quite difficult or impossible to establish if they are benign or malignant lesions. An extraordinarily large number of studies have been made in attempts to solve this problem; regrettably, the histological criteria proposed and the various special sophisticated techniques employed have proven to be ineffective in making this distinction with confidence.
To explore the possible causes for this diagnostic failure and an attempt to identify the source of this problem.
A historical and technical analysis of the specialized literature is performed, critically evaluating the main points of this controversial topic.
The reasons for the diagnostic failure in Spitzoid neoplasms are not clear but could be the result of inappropriate conceptual representation. The analysis of available data and a rational review of old and new assumptions and concepts may suggest a different representation for Spitzoid neoplasms: Spitz nevus, atypical Spitz tumor and Spitzoid melanoma, rather than being three different tumors that are difficult or impossible to distinguish with assurance, could be viewed as one unique entity, Spitz tumor (ST). This tumor is a low-grade malignant neoplasm, in which the amount of intrinsic risk is variable, ranging from very low to high (ST1, ST2, ST3), and malignant potential could be estimated.
The proposed alternative representation of Spitzoid neoplasms as a unique tumor may help in overcoming the difficulty in diagnosis of these tumors.
Spitzoid肿瘤可能带来重大的诊断难题，因为其中一部分肿瘤很难甚至无法确定其是良性还是恶性病变。为解决这一问题已经开展了大量研究；遗憾的是，所提出的组织学标准以及采用的各种复杂特殊技术在可靠地区分这些肿瘤方面均被证明是无效的。
探讨这种诊断失败的可能原因，并尝试找出该问题的根源。
对专业文献进行历史和技术分析，批判性地评估这一有争议主题的要点。
Spitzoid肿瘤诊断失败的原因尚不清楚，但可能是概念表述不当所致。对现有数据的分析以及对新旧假设和概念进行合理审视，可能会为Spitzoid肿瘤提出一种不同的表述：Spitz痣、非典型Spitz肿瘤和Spitzoid黑色素瘤，与其被视为三种难以或无法可靠区分的不同肿瘤，不如被看作是一个独特实体，即Spitz肿瘤（ST）。这种肿瘤是一种低级别恶性肿瘤，其内在风险程度各不相同，从非常低到高（ST1、ST2、ST3），并且其恶性潜能是可以估计的。
将Spitzoid肿瘤作为一种独特肿瘤提出替代表述，可能有助于克服这些肿瘤在诊断上的困难。
