Melanoma in Child
Predisposing conditions for melanoma in children include giant congenital melanocytic nevi, dysplastic nevus syndromes, xeroderma pigmentosum, and immunodeficiency states (either inherited or iatrogenic). While a family history of melanoma, a history of severe sunburns, multiple atypical nevi, the inability to tan, or red hair color are predisposing conditions to adult melanoma, the relevance to development of childhood melanoma is unknown. Approximately 30% of pediatric melanomas arise from giant congenital nevi, while another 50% arise de novo.
It has been noted in the literature that the ABCD criteria (asymmetry, border irregularity, color variegation, diameter >6 mm) for diagnosis of melanoma in adults are often absent in melanomas arising in the pediatric population, especially in children 10 years of age and younger. The absence of these features may contribute to delay in diagnosis of melanoma in this age group. ABCD criteria specific to the pediatric population have been proposed:
A: Amelanotic. Many pediatric melanomas are pink, red, or flesh-colored. Some have resembled warts or lobular capillary hemangiomas (pyogenic granulomas).
B: Bleeding, Bump (papulonodule)
C: Color uniformity (rather than variegation)
D: De novo, any Diameter
The "E" of ABCDE in adults (evolution) is a criterion that does apply to melanoma in this age group.
It is recommended that both sets of ABCD criteria be employed to improve early detection of pediatric melanoma.
In a review comparing pediatric melanoma with adult melanoma, it was found that pediatric patients often have a thicker depth of invasion at the time of diagnosis as well as a higher incidence of positive lymph node metastasis. Interestingly, however, there was no statistical difference in the 5-year and 10-year survival between the two groups. Further study of thickness as a prognostic factor, and other prognostic factors in childhood melanoma, is warranted.
Related topic: Amelanotic Melanoma
C43.9 – Malignant melanoma of skin, unspecified
372244006 – Malignant melanoma
- Spitz nevus
- Compound nevus
- Atypical nevus
- Congenital nevus
- Blue nevus
- Lentigo simplex
- Lobular capillary hemangioma – Friable, glistening surface.
- Hemangioma – Cherry, thrombosed.
- Dermatofibroma – Firm tan or brown papule with positive dimple sign.
- Halo nevus – Tan or brown papule with surrounding depigmented patch.
- Tinea nigra
- Subungual hematoma
- Talon noir (black heel)
- Longitudinal melanonychia (a pigmented line along the length of a nail plate) may be a benign finding or a sign of a nail matrix melanoma. Hutchinson's sign – the presence of pigment in the proximal nail fold in a patient with longitudinal melanonychia – should prompt consideration of a nail matrix melanoma.