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The Application of 1% Methylene Blue Dye As a Single Technique in Breast Cancer Sentinel Node Biopsy

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Atypical Spitz tumour with positive sentinel lymph node.

Davide Lazzeri¹, Marzia Pieroni, Maurizio De Rosa

¹Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Pisa, Italy. davidelazzeri@gmail.com

Journal of Plastic Surgery and Hand Surgery

|December 6, 2012

Summary

Atypical Spitz tumours in young patients often involve sentinel lymph nodes but typically have a favorable prognosis. Further surveillance is needed to clarify the implications of nodal involvement in these rare pigmented lesions.

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Area of Science:

Dermatology
Surgical Oncology
Pathology

Background:

Atypical Spitz tumours are rare pigmented lesions with uncertain biologic potential.
Sentinel lymph node biopsy is a staging procedure for melanoma and other cancers.
The management of atypical Spitz tumours with positive sentinel nodes remains controversial.

Observation:

A 16-year-old patient with an atypical Spitz tumour had a positive inguinal sentinel node but no further nodal involvement after lymphadenectomy.
The patient remained disease-free for 39 months.
Literature review indicates 68 of 147 patients (46%) with atypical Spitz tumours and sentinel node mapping had positive nodes.

Findings:

All patients with positive sentinel nodes, including this case, had a favorable prognosis with a mean follow-up of 35.8 months.

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Despite positive sentinel nodes, atypical Spitz tumours do not appear to behave like conventional melanomas.

The biologic potential of atypical Spitz tumours cannot always be accurately assessed by sentinel lymph node status.

Implications:

Sentinel lymph node biopsy may have a therapeutic role in malignant lesions but carries morbidity and interpretation challenges for atypical Spitz tumours.
Current management strategies may lead to under-treatment or over-treatment due to diagnostic uncertainties.
Sentinel lymph node biopsy should be reserved for carefully selected patients with atypical Spitz tumours, and longer follow-up is necessary.