Clinical features and outcomes of spitzoid proliferations in children and adolescents

Summary

Background

Spitzoid proliferations range from Spitz nevi to melanomas, and there are few studies describing clinical features and outcomes in the pediatric population.

Objectives

Determine clinical features and outcomes of a large pediatric cohort with histopathologically‐confirmed Spitz tumors.

Methods

Retrospective cohort study of Boston Children's Hospital patients younger than 20 years with a histopathologic diagnosis of spitzoid proliferation from 1/1/1994 – 10/23/2012.

Results

Five hundred ninety‐five patients with 622 spitzoid proliferations were identified [median age = 7.4 years, (25^th, 75^th) quartiles = (4.6, 11.7) years]. Five hundred twelve (82.3%) proliferations were typical, 107 (17.2.%) were atypical, and 3 (0.5%) were melanomas. Median age at biopsy was 7.4, 7.2, and 17.2 years, respectively, and there was a significant difference in age at biopsy for patients with typical or atypical proliferations versus melanoma (p<0.01). Among samples with positive margins (n = 153), 55.1% (54/98) of typical proliferations, 77.4% (41/53) of atypical proliferations, and 100.0% (2/2) of melanomas were re‐excised. Six patients had sentinel lymph node biopsy performed, with 3 patients demonstrating nodes positive for melanocytic cells. With median follow‐up of 4.1 years for the full cohort, there were no related deaths.

Conclusion

Spitz tumors have strikingly benign outcomes in the pediatric population, though this study is limited by low number of melanomas and restriction to a single pediatric institution. Aggressive management recommendations should be reconsidered for children and adolescents with banal‐appearing Spitz nevi, based upon the clinically indolent behavior in this cohort.

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