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Currently, no reliable histopathological criteria or molecular marker is known to distinguish borderline from overtly malignant neoplasms. Because\n                    <jats:italic>TERT<\/jats:italic>\n                    promoter (\n                    <jats:italic>TERT<\/jats:italic>\n                    -p) mutations are common in inherently aggressive cutaneous conventional melanoma, we sought to evaluate their prognostic significance in spitzoid neoplasms. We analyzed tumors labeled as atypical Spitz tumor or spitzoid melanoma from 56 patients with available follow-up data for the association of\n                    <jats:italic>TERT<\/jats:italic>\n                    -p mutations, biallelic\n                    <jats:italic>CDKN2A<\/jats:italic>\n                    deletion, biallelic\n                    <jats:italic>PTEN<\/jats:italic>\n                    deletion, kinase fusions,\n                    <jats:italic>BRAF<\/jats:italic>\n                    \/\n                    <jats:italic>NRAS<\/jats:italic>\n                    mutations, nodal status and histopathological parameters with risk of hematogenous metastasis. Four patients died of disseminated disease and 52 patients were alive and disease free without extranodal metastasis (median follow-up, 32.5 months). We found\n                    <jats:italic>TERT<\/jats:italic>\n                    -p mutations in samples from the 4 patients who developed hematogenous metastasis but in none of tumors from patients who had favorable outcomes. Presence of\n                    <jats:italic>TERT<\/jats:italic>\n                    -p mutations was the most significant predictor of haematogenous dissemination (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.0001) among variables analyzed. We conclude that\n                    <jats:italic>TERT-<\/jats:italic>\n                    p mutations identify a clinically high-risk subset of patients with spitzoid tumors. Application of\n                    <jats:italic>TERT-<\/jats:italic>\n                    p mutational assays for risk stratification in the clinic requires large-scale validation.\n                  <\/jats:p>","DOI":"10.1038\/srep11200","type":"journal-article","created":{"date-parts":[[2015,6,10]],"date-time":"2015-06-10T13:11:44Z","timestamp":1433941904000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":157,"title":["TERT Promoter Mutations Are Predictive of Aggressive Clinical Behavior in Patients with Spitzoid Melanocytic Neoplasms"],"prefix":"10.1038","volume":"5","author":[{"given":"Seungjae","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond L.","family":"Barnhill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reinhard","family":"Dummer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Dalton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianrong","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Pappo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armita","family":"Bahrami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2015,6,10]]},"reference":[{"key":"BFsrep11200_CR1","first-page":"591","volume":"24","author":"S Spitz","year":"1948","unstructured":"Spitz, S. 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