Malignant melanoma is a relatively rare phenomenon in children. Reports relating to prognosis offer varying survival rates when contrasted with melanomas of comparable thickness in adults. Our patients have tended to exhibit a higher than expected incidence of thick melanomas. We postulate that the predominance of thick lesions is the result of delayed diagnosis of a rare entity. It is interesting that the children in our practice at highest risk for the development of melanoma have had acquired rather than congenital pigmented lesions. It should be noted, however, that one patient did develop melanoma from a congenital lesion. We advocate that any pigmented lesion that develops an irregular border, a focal increase or decrease in pigmentation, an irregular topography, or ulceration should be evaluated immediately by excisional biopsy. The depth of invasion of the primary tumor in children, as in adults, has been reported to correlate with prognosis. Our experience indicates a survival time that is comparable or possibly superior to that found in adults. Particular vigilance should be maintained in children who have risk factors for the development of malignant melanoma. Groups known to be at increased risk include patients with xeroderma pigmentosum, dysplastic nevus syndrome and giant congenital melanocytic nevus, patients who are immunosuppressed, and those with congenital nevi undergoing change. Although the above groups may identify children at increased risk for the development of melanoma, only one of our prepubertal patients could be considered to be at risk prior to development of melanoma. The primary treatment of malignant melanoma in children is surgical. Excisional biopsies should be performed of suspected lesions. The biopsy should include the full thickness of the dermis to facilitate measurement of the depth of tissue invasion (measured from the granular layer of epidermis) if a malignancy is confirmed histologically. Once the diagnosis has been established surgical excision with adequate margins should be performed. Chemotherapeutic agents and radiation did not prove efficacious in the treatment of our cases of disseminated melanoma. The inadequacy of secondary modalities for treatment of melanoma further underscores the necessity for early diagnosis and prompt surgical treatment of this disorder in children. Early diagnosis of malignant melanoma in children is dependent on recognition of the fact that this tumor occurs in children. Regardless of the age of the patient, excisional biopsies should be performed when lesions possess clinical features suggestive of malignancy. Prompt identification of pediatric patients with melanoma should result in increased survival. Our patients with thick lesions who were diagnosed prior to distant metastasis appear to have a comparable or improved prognosis relative to their adult counterparts.

Copyright © 1998. All rights reserved.

Click here to visit the Cancer News on the Net ®

---

Cancer News on the Net wishes to thank Dr Pensler for contributing this fine article to our service!