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
Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA, USA.
Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
J Cutan Pathol. 2017 Jan;44(1):5-14. doi: 10.1111/cup.12826. Epub 2016 Oct 28.
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.
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).
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).
Spitzoid lesions are often not classified in any standardized way, evoke uncertainty in diagnosis by pathologists, and elicit variability in treatment recommendations.
斯皮茨痣、非典型斯皮茨肿瘤和斯皮茨样黑色素瘤（“斯皮茨样病变”）是具有争议且了解甚少的皮肤黑素细胞性病变，在组织学上难以诊断。目前尚不清楚病理学家如何使用这些术语。
我们利用黑色素瘤病理学（M-Path）研究数据库中的数据描述了与斯皮茨相关术语的使用情况，该数据库包含病理学家对活检玻片的解读，这是一项评估美国执业病理学家（N = 187）对黑素细胞性病变诊断的全国性研究（对240个总测试病例进行了8976次独立诊断评估，每个病例1张玻片）。
大多数病理学家（90%）使用了与斯皮茨相关的术语。然而，在哪些特定病变被诊断为斯皮茨样以及相应的治疗建议方面存在显著差异。建议范围从“无需进一步治疗”到“广泛切除10毫米或更大范围”，没有任何一个类别获得超过50%的回应。对于斯皮茨样黑色素瘤的诊断，90%的病理学家建议切除边缘≥10毫米。与其他黑素细胞增生相比，病理学家报告对这些病变的诊断信心较低，并且更有可能寻求二次意见和额外的临床信息（所有p < 0.05）。
斯皮茨样病变通常没有以任何标准化方式分类，在病理学家的诊断中引发不确定性，并在治疗建议中引发变异性。
