"Spitzoid Features" concerns

[Lisette]

(A few prior entries have addressed Spitz nevi, so I’m hoping it’s okay to post here, too.)

Recently my dermatologist notified me that of two lesions removed from my thigh, one (relatively new and dark with an almost-black spot, as I remember) was a spitzoid, benign but apparently of concern, as the other biopsy result was “the good news.”

The pathology report is as follows:

Diagnosis:

LENTIGINOUS JUNCTIONAL MELANOCYTIC NEVUS WITH SPITZOID FEATURES

Note: The lesion appears to be completely removed in the planes of sections examined.

Microscopic Description:

There is hyperpigmentation of the basal cell layer keratinocytes, slight elongation of rete ridges, and melanocytes, mostly as solitary units but also in nests, at the dermo-epidermal junction. Bridging is present between some rete ridges.

There is a follow-up appointment scheduled, but until then I’ve been researching some and reading (extremely helpful) posts in this forum. Still, confusion and several questions remain…

1. The dermatologist called it a spitzoid and mentioned atypia. I’m having trouble correlating that

to the pathology report or any other information. Is this a Spitz nevus, atypical spitzoid nevus (ASN), or neither? And is atypia understood by the description without identifying whether it’s mild, moderate, etc.? It seems they don’t occur as frequently in my age group (50s), and that

even experienced dermatopathologists sometimes have difficulty agreeing where these lesions belong on the benign-to-malignant spectrum.

2. Should I get a second opinion? I see that both Dr. Bastian and Dr. Mihm have been mentioned as Spitz nevus experts.

3. Is excision with wider margins recommended?

Thanks to anyone who might be able to help me sort through this.

[Worrywart]

Welcome to MIF. If I were you, I’d get the ball rolling on the second opinion on pathology and when you get those results, go from there. This could just be (and most likely is) a benign spitz, but they are very difficult to read pathologically so need an expert eye.

[Lisette]

Thanks for your quick reply. Rather than waiting for my dermatology appointment, I will arrange for another opinion now. It looks like Dr. Bastian is back on the west coast – perhaps UCSF? – and no longer at MSK. Dr. Mihm’s contact info is available online. Apparently both are highly recommended, so I should feel confident with either expert.

[Lisette]

So I thought that the more difficult part of a second opinion might be waiting for the results. After finding names, addresses and talking to a rep at UCSF, I called my dermatologist’s office to see what info I should provide to help obtain another opinion, and I was told by experienced staff that I’m on my own. Really? If I didn’t already have an appt scheduled for next week, I would have left a message to speak directly to my derm. I don’t mind doing the legwork, but this is all new to me. I still don’t understand how the paperwork and slides are coordinated in the shipping, don’t know what my insurance requires, and a referring physician’s name is needed anyway. And wouldn’t I need the doctor to explain the report? Guess I have more phone calls on Monday.

Is this how second opinion requests are usually processed?!

[cohanja]

Contact them first before sending your slides, though, I think there is a form to also fill out with demographics, billing info, etc…

Martin C. Mihm Jr., M.D., F.A.C.P.

SKADA

One Broadway

Suite 14

Cambridge, MA 02142

Phone-617-401-2231

You might have better luck and a quicker response by sending an email directly to this person:

Rolanda Flammia

Assistant to Martin C. Mihm Jr., M.D.

Director, Melanoma Program

Department of Dermatology

Brigham and Women’s Hospital

41 Avenue Louis Pasteur

Alumnae Hall, Room 317

Boston, MA 02115

Phone-617-264-5910

Fax-617-264-3021

E-mail- rflammia@partners.org

[Lisette]

Cohanja, thanks for posting the contact names and addresses. That info will help others in the future, as well!

What threw me initially was reading on the different forums that a second opinion was relatively easily obtained by asking the dermatologist to send the slides out. Makes sense but, at least in this case, my doctor will not get involved in any way. (But does want a copy of the second opinion report.)

Now just waiting…

[Lisette]

As a follow-up, I did seek out a second opinion and the lesion with spitzoid features is benign. Eased my mind. Without the forum I wouldn’t have known who to contact for another reading or how to start the process. Great appreciation for this entire site.

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