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Identifying Melanoma in Children

Forums Pediatric & AYA Melanoma Community Identifying Melanoma in Children

  • Post
    JerryfromFauq
    Participant

      Pediatric melanomas often present with features that are clinically and histopathologically different compared with those in adults, and atypical presentation may delay diagnosis.

      Pediatric melanomas often present with features that are clinically and histopathologically different compared with those in adults, and atypical presentation may delay diagnosis. Results of this retrospective study indicated that the ABCD criteria alone are inadequate for detecting melanoma in children, and the investigators proposed that additional ABCD criteria (Amelanotic; Bleeding, Bump; Color uniformity; De novo, any Diameter) be utilized as well, acknowledging that the specificity and sensitivity of these criteria must be validated.

      Melanoma has become the “Great Obsession” for many dermatologists because too many young healthy people die because, one, they do not understand the hazards of tanning and, two, do not know the significance of the “ugly duckling sign,” the ABCDs of melanoma, and, most importantly for the diagnosis of early melanoma, the importance of showing their physician any “E”—evolving or changing mole. It is part of our job to educate the public about these issues.

      A recent article by Cordoro et al complicates this matter a bit. We have always known that melanomas do not always show classic features to promote early identification; hence, the importance of identifying any evidence of evolution or change. In pediatric melanoma, a significant majority of lesions fail to show ABCD criteria, which commonly causes a delay in diagnosis. In a study of 70 pediatric melanoma patients, many of the lesions were amelanotic, arose de novo rather than representing a change in a mole, had uniform color, and often were smaller than a pencil eraser. Bleeding was a key finding. While melanoma in children is rare, unusual pigmented lesions should be either examined with a dermatoscope and/or biopsied. 


      ABSTRACT

      Background: Clinical and histopathologic features of childhood melanoma are poorly characterized. Atypical clinical presentations and ambiguous microscopic findings may contribute to diagnostic delays.

      Objectives: We sought to determine whether conventional ABCDE melanoma detection criteria (Asym- metry, Border irregularity, Color variegation, Diameter [6 mm, Evolution [any morphologic or sympto- matic change in the lesion]) adequately detects pediatric melanoma and to evaluate clinicopathologic and outcome differences between younger and older children.

      Methods: This was a retrospective study of children given the diagnosis of melanoma (N = 60) or ambiguous melanocytic tumors treated as melanoma (N = 10) before age 20 years from 1984 to 2009 at the University of California, San Francisco. Seventy patients were divided into 2 age groups: 0 to 10 years (N = 19, group A) and 11 to 19 years (N = 51, group B). Clinical, histopathologic, and outcomes data were collected. Main outcome measures were time from diagnosis to death and predictors of metastasis and death.

      Results: In all, 60% of group A and 40% of group B children did not present with conventional ABCDE criteria. Rather, amelanosis, bleeding, ‘‘bumps,’’ uniform color, variable diameter, and de novo develop- ment were most common. Histopathological subtypes differed significantly between groups (P = .002). In all, 44% were histopathologically unclassifiable using current melanoma subtypes. Stage IIA disease or higher comprised 92% and 46% of groups A and B, respectively (P = .05). Ten patients died: 1 in group A and 9 in group B. Of these, 70% had amelanotic lesions, and 60% had at least 1 major risk factor. Breslow thickness predicted metastasis (adjusted odds ratio 12.8 [CI 1.4-115]).

      Limitations: The retrospective design resulted in incomplete data capture.

      Conclusion: Additional ABCD detection criteria (Amelanotic; Bleeding, Bump; Color uniformity; De novo, any Diameter) used together with conventional ABCDE criteria may facilitate earlier recognition and treatment of melanoma in children.

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        Tim–MRF
        Guest

          Jerry:

          This is an important study, particularly as melanoma is a growing part of everyday conversation.  Children develop benign tumors called Spitz Nevi that are often confused with melanoma.  So, some children are diagnosed with melanoma and put into treatment, but they never had melanoma.  Others are having their melanomas missed.  Both situations are tragic.

          Fortunately pediatric melanoma is rare.  I have spoken with a couple of companies who have launched clinical trials in pediatric melanoma and they expect to take years to fully enroll those trials.

          Tim–MRF

          Tim–MRF
          Guest

            Jerry:

            This is an important study, particularly as melanoma is a growing part of everyday conversation.  Children develop benign tumors called Spitz Nevi that are often confused with melanoma.  So, some children are diagnosed with melanoma and put into treatment, but they never had melanoma.  Others are having their melanomas missed.  Both situations are tragic.

            Fortunately pediatric melanoma is rare.  I have spoken with a couple of companies who have launched clinical trials in pediatric melanoma and they expect to take years to fully enroll those trials.

            Tim–MRF

            Tim–MRF
            Guest

              Jerry:

              This is an important study, particularly as melanoma is a growing part of everyday conversation.  Children develop benign tumors called Spitz Nevi that are often confused with melanoma.  So, some children are diagnosed with melanoma and put into treatment, but they never had melanoma.  Others are having their melanomas missed.  Both situations are tragic.

              Fortunately pediatric melanoma is rare.  I have spoken with a couple of companies who have launched clinical trials in pediatric melanoma and they expect to take years to fully enroll those trials.

              Tim–MRF

              awillett1991
              Participant
                Jerry – thanks so much for posting this, our melanoma runs in the family and so far only one of our children is being seen regularly by a derm, she has the same skin as me and my dad ๐Ÿ™ she has also developed vitiligo strangely enough. Good info I hadn’t seen.

                Amy

                awillett1991
                Participant
                  Jerry – thanks so much for posting this, our melanoma runs in the family and so far only one of our children is being seen regularly by a derm, she has the same skin as me and my dad ๐Ÿ™ she has also developed vitiligo strangely enough. Good info I hadn’t seen.

                  Amy

                  awillett1991
                  Participant
                    Jerry – thanks so much for posting this, our melanoma runs in the family and so far only one of our children is being seen regularly by a derm, she has the same skin as me and my dad ๐Ÿ™ she has also developed vitiligo strangely enough. Good info I hadn’t seen.

                    Amy

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