Atypical and anomalous melanocytic lesions are tumors that cannot be determined by microscopy to be certainly benign or fully malignant. The malignant potential of these borderline lesions is unknown and logical determination of best therapy is challenging, in particular whether lymphatic mapping and sentinel node biopsy have a place in their management. Lesions that fall into this category include atypical Spitzoid lesions, atypical cellular blue nevi, combined nevi, deep penetrating nevi, ancient nevi, desmoplastic nevi, balloon cell nevi and proliferation nodules of congenital nevi. We report our experience managing patients with these problematic tumors and discuss our approaches to determining the true location of lesional cells in sentinel nodes.
Cochran AJ, Binder S, Morton DL. The role of lymphatic mapping and sentinel node biopsy in the management of atypical and anomalous melanocytic lesions.
"8 Otherwise, Barnhill (2006) suggested a well-defined protocol for the rigorous evaluation of Spitzoid lesions according to histopathological, clinical , and ancillary features. 2 Cochran et al. (2010) recently observed that atypical Spitz tumours cannot be shown to be definitely benign on the basis of microscopic examination, but do not possess microscopic features that would allow their confident identification as fully malignant. 9 Because of this, the use of SLNB, as for melanoma staging, has "
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the incidence of lymph node metastases in patients with atypical Spitz nevi (ASN) after sentinel lymph node biopsy (SLNB) and during follow-up, and to assess the diagnostic value of the surgical procedure.
At the National Cancer Institute of Naples, Italy, 40 patients with ASN underwent SLNB between 2003 and 2011. Medical records were reviewed and all slides of the primary tumours were retrieved, rendered separately, and assessed by four experienced dermatopathologists from two different academic institutions. Each member of the review panel assessed slides separately without recourse to medical notes and blinded to each others' diagnosis. All patients were treated with wide local excision and SLN biopsy according to the standard procedure. All cases were followed up to assess outcomes.
The original diagnosis of ASN was confirmed in all 40 cases. No sentinel node positivity was recorded, and no patients developed nodal involvement during a median follow-up of 46 months (range 16-103). All patients were alive and without evidence of locoregional or distant relapse at time of review.
In our experience, ASN were not associated with metastatic potential. Surgical staging procedures are not justified and careful clinical surveillance is adequate.
European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 06/2012; 38(10):932-5. DOI:10.1016/j.ejso.2012.05.010 · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Applications that require the use of softball-sized or smaller robots impose size and power constraints that prohibit the use of active sensors such as ladar or sonar for mapping and localization. The small size of such robots also makes passive stereo vision impractical due to the limited baseline. As a result, map building capabilities for such robots will need to be based on structure from motion using monocular sequences of images. This paper presents a novel algorithm for estimation of 2-D hallway structure and robot motion given a set of feature observations from multiple images. The 2-D structure from motion algorithm is posed in a way that is linear in Cartesian coordinates given a set of camera rotations. Given an observation of a feature from a camera position, for a specified rotation of the camera's coordinate system relative to the world there is a linear constraint that the camera's location and the feature's location should both lie along the line of sight between the camera and the feature. Starting with an initial set of camera orientations, the algorithm iteratively switches between refining the estimated camera and feature positions and refining the estimated camera rotations. The performance of the structure from motion algorithm is demonstrated by comparison of the algorithm results on a sequence of images to the manually measured true structure of a typical hallway.
[Show abstract][Hide abstract] ABSTRACT: Combined melanocytic nevi are composed of 2 or more distinct populations of nevomelanocytes. Most commonly used to describe the combination of blue nevi with common nevi, it may also be applied to other combinations of benign melanocytic proliferations, including Spitz nevi and nevi with deep dermal pigmented nevomelanocytes. We report the incidence and distribution of these tumors at the Massachusetts General Hospital over the past decade and review guidelines for diagnostic criteria and nomenclature. Between 2000 and 2010 we identified 511 cases of combined nevi, represented by 4 histologically distinct diagnostic categories: (1) blue nevus, (2) nevi with deep dermal pigmented nevomelanocytes (plexiform/deep penetrating, inverted type A/clonal), (3) Spitz or pigmented spindled cell nevus, combined with another type of nevus (usually common or dysplastic), and (4) other combinations including 2 or more nevus types. Nearly one fifth of these tumors displayed atypical features; atypia was observed more often in combined nevi with Spitz or deep pigmented elements (26 of 55, 47%, and 25 of 98, 26%, respectively) than in combined common and blue nevi (37 of 336, 11%). Clinical follow-up data were available for 83% of the patients with atypical combined nevi; none developed recurrence or metastasis with a mean follow-up of over 4 years.
The American journal of surgical pathology 08/2011; 35(10):1540-8. DOI:10.1097/PAS.0b013e31822e9f5e · 5.15 Impact Factor
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