Histomorphologic assessment and interobserver diagnostic reproducibility of atypical spitzoid melanocytic neoplasms with long-term follow-up

Pedram Gerami*, Klaus Busam, Alistair Cochran, Martin G. Cook, Lyn M. Duncan, David E. Elder, Douglas R. Fullen, Joan Guitart, Philip E. Leboit, Martin C. Mihm, Victor G. Prieto, Michael S. Rabkin, Richard A. Scolyer, Xiaowei Xu, Sook Jung Yun, Roxana Obregon, Pedram Yazdan, Chelsea Cooper, Bing Bing Weitner, Alfred RademakerRaymond L. Barnhill

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

120 Scopus citations


Predicting clinical behavior of atypical Spitz tumors remains problematic. In this study, we assessed interobserver agreement of diagnosis by 13 expert dermatopathologists for atypical Spitz tumors (n=75). We determined which histomorphologic features were most heavily weighted for their diagnostic significance by the experts and also which histomorphologic features had a statistically significant correlation with clinical outcome. There was a low interobserver agreement among the experts in categorizing lesions as malignant versus nonmalignant (κ=0.30). The histomorphologic features that were given the most diagnostic significance by the experts were: consumption of the epidermis, atypical mitoses, high-grade cytologic atypia, and mitotic rate. Conversely, the histomorphologic features that most correlated with disease progression were: frequent mitoses, deep mitoses, asymmetry, high-grade cytologic atypia, and ulceration. The presence and/or pattern of pagetoid spread, consumption of the epidermis, and lymphoid aggregates demonstrated no association with clinical behavior. The results support the assertion that there is a lack of consensus in the assessment of atypical Spitz tumors by expert dermatopathologists. Importantly, many features used to distinguish conventional melanoma from nevi were not useful in predicting the behavior of atypical Spitz tumors. This study may provide some guidance regarding histologic assessment of these enigmatic tumors.

Original languageEnglish (US)
Pages (from-to)934-940
Number of pages7
JournalAmerican Journal of Surgical Pathology
Issue number7
StatePublished - Jul 1 2014


  • Spitz nevus
  • Spitz tumor
  • atypical Spitz tumor
  • interobserver
  • melanoma
  • spitzoid melanoma

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine


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