Malignant melanoma in childhood and adolescence

Abstract

children lesions were amelanotic. In one girl (case no. 2), the lesion was initially diagnosed as a clinically suspect pyogenic granuloma. The first excochleation was performed in another institution without a histologic exam. A recurrence of the lesion took place a month later when the girl was referred to our institution. A pathological-histological examination of the excised material confirmed MM. In two children, MM was associated with a pre-existent lesion, a small congenital nevus, according to the history provided by parents but histology could not confirm the association between MM and congenital nevi.Histological diagnosis of MM in childhood is often difficult; 4,5 so all of our specimens were sent for external confirmation to an independent pathologist in another institution. Some melanocytic lesions in children cannot be easily histologically classified as either benign or malignant. Such 'indeterminate' or 'borderline' lesions are frequently diagnosed as melanocytic tumours of uncertain malignant potential and it is recommended to treat and follow them equally aggressively as MM. 6 In one girl (case no. 5), the histological result was unclear; so three independent pathologists from three different institutions agreed that, although the finding was ambiguous, malignancy could not be excluded and for that reason further procedure should be the same as in a melanoma of 4.1 mm thickness, Breslow 4, Clark 4. Children on average have thicker MM than adolescents (late biopsy, atypical clinical pictures). 7 The average thickness of tumours in children 0-14 was 3.93 mm whereas in adolescents 15-18 it was 1.78 mm.All 10 patients underwent a wide re-excision of the tumour site. Sentinel lymph node biopsy was performed in eight patients (MM thicker than 1 mm) and it was positive in two of them. Both patients with positive sentinel lymph node had therapeutic dissection of lymph nodes and then received interferon and decarbazine. None among our patients had remote visceral metastases. All patients in our study are doing well, and even those two who had confirmed metastases in lymph nodes were free of metastases after 48 and 22 months respectively.In conclusion, MM is a rare childhood and adolescent tumour. Its clinical presentation is frequently atypical and it commonly arises from unchanged skin and without pre-disposing factors. Every year our institution registers an increase in the number of diagnosed MM; fortunately the incidence of MM in children and adolescents does not show the same upward trend. We have diagnosed 0-3 cases ⁄ year. The increase of MM diagnosed in our institution does not necessarily mean an increase of MM in the region or in the country, but it does show that our Referral Centre is becoming recognized as the best centre in the region so a growing number of patients are referred to our institution. 13: 225-233. 3 Ferrari A, Bono A, Baldi M et al. Does melanoma behave differently in younger children than in adults? A retrospective study of 33 cases of childhood melanoma from a single inst...

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