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Imaging mass spectrometry assists in the classification of diagnostically challenging atypical Spitzoid neoplasms

Published:August 05, 2016DOI:https://doi.org/10.1016/j.jaad.2016.07.007

      Background

      Previously, using imaging mass spectrometry (IMS), we discovered proteomic differences between Spitz nevi and Spitzoid melanomas.

      Objective

      We sought to determine whether IMS can assist in the classification of diagnostically challenging atypical Spitzoid neoplasms (ASN), to compare and correlate the IMS and histopathological diagnoses with clinical behavior.

      Methods

      We conducted a retrospective collaborative study involving centers from 11 countries and 11 US institutions analyzing 102 ASNs by IMS. Patients were divided into clinical groups 1 to 4 representing best to worst clinical behavior. The association among IMS findings, histopathological diagnoses, and clinical groups was assessed.

      Results

      There was a strong association between a diagnosis of Spitzoid melanoma by IMS and lesions categorized as clinical groups 2, 3, and 4 (recurrence of disease, metastases, or death) compared with clinical group 1 (no recurrence or metastasis beyond a sentinel node) (P < .0001). Older age and greater tumor thickness were strongly associated with poorer outcome (P = .01).

      Conclusions

      IMS diagnosis of ASN better predicted clinical outcome than histopathology. Diagnosis of Spitzoid melanoma by IMS was strongly associated with aggressive clinical behavior. IMS analysis using a proteomic signature may improve the diagnosis and prediction of outcome/risk stratification for patients with ASN.

      Key words

      Abbreviations used:

      AJCC (American Joint Committee on Cancer), ANED (alive with no evidence of disease), ASN (atypical Spitzoid neoplasm), IMS (imaging mass spectrometry), SLN (sentinel lymph node), SM (Spitzoid melanoma), SN (Spitz nevus)
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