Shall all Spitz-like tumours be excised?

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Published: 22 Nov 2018
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Dr Aimilios Lallas - Dr Aimilios Lallas, Aristotle University of Thessaloniki, Thessaloniki, Greece

Dr Aimilios Lallas speaks with ecancer at the EADO 2018 congress in Barcelona on whether all Spitz-like tumours should be excised.

Dr Lallas explains that one of the main arguments for all tumours to be excised is that monitoring the lesions can sometimes lead to wrong conclusions due to the peculiar nature of the tumour's biology: therefore it is safer to excise everything.

However the probability of this kind of melanoma (especially in children) is extremely low, and Dr Lallas understands we could be more selective in this category.

ecancer's filming has been kindly supported by Amgen through the ecancer Global Foundation. ecancer is editorially independent and there is no influence over content.

We had a nice debate; the question was how should we manage Spitzoid looking tumours? The problem is basically that Spitz nevi, which is a nevous type, there is a significant overlap between Spitz nevi and melanoma with Spitzoid characteristics. So this is the source of the problem. Given this overlap we are trying to develop strategies in order to avoid missing melanomas that might look like Spitz nevi but, at the same time, if possible to perform not many unnecessary excisions of nevi. So this is why the topic is complicated, precisely because there is this overlap between a benign tumour and a malignant one.

In the debate first I was supporting the argument that it’s safer to excise everything and it’s rather hopeless to try to avoid excisions without putting ourselves at risk. Rainer, on the other hand, was trying to argue for the opinion that of course we have to excise in certain cases but maybe in some scenarios, especially in children, we can avoid some unnecessary excisions. So this is the overview of the debate we had.

What were some of the main arguments ‘for’ and ‘against’ complete excision?

The main arguments for are, first of all, the overlap, the existence of the overlap which is anyhow out of any question. The second argument is that even in children the alternative option, which is monitoring these lesions, sometimes is not beneficial because it leads to wrong conclusions. Why? Because these nevi, although they are benign, they have a very peculiar biology. So they grow in a very peculiar way, they grow fast, rapidly, sometimes not symmetrically. So for monitoring them provides false information in some cases, of course. So monitoring doesn’t make sense and then excise everything, this is the argument for yes.

The main argument for no which is, let’s say, in fact the management recommendation that most of us share, so we are trying to be more selective, this is the truth. The main argument is that especially in children the probability of Spitzoid melanoma is extremely low and, in particular, is very low in the context of a flat Spitzoid looking lesion. So at least in this category maybe we can be more selective and avoid these excisions, this is the main argument.

Do you think the debate has changed anyone’s mind?

I’m not sure but I am pretty sure that it provided insights on why the problem exists, which are the potential risks that we should have in mind as clinicians in order to take our decisions in the real clinical practice.

What was your experience of this year’s conference and why are they important to the field?

Great, the experience is great by all means, I would say. The organisation is perfect, the topics are rich, they cover almost everything in skin oncology from diagnosis to treatment of advanced stages. And definitely it’s a very useful meeting, precisely because it brings together people working in different parts of the puzzle of skin cancer. So some of them work mainly on diagnosis, some of them work mainly on treatment, many of us working on both. So all of these professionals of different specialties, some are dermatologists, some others are oncologists, come together and this is, of course, extremely beneficial because you come in contact with the way that other people face the same problems that you also have to face in your everyday work.