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Problematic melanocytic lesions in the pediatric setting are represented by congenital nevi and Spitz nevi.
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Congenital melanocytic nevi carry a higher risk of melanoma development as compared with common nevi. The risk of melanoma is proportional to the nevus size; thus, particular attention should be paid to large congenital nevi.
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Childhood melanoma often lacks the classical features of pigmented melanoma, and it is more often an amelanotic and nodular lesion resembling pyogenic granuloma or
Problematic Lesions in Children
Section snippets
Key points
Spitz/Reed nevi
Since the first description by Sophie Spitz in 1948,15 much work has been conducted in elucidating the clinico/pathologic variability of spitzoid lesions. Currently, common Spitz and Reed nevi are considered benign melanocytic proliferations that frequently occur in children and are histopathologically classified as benign without difficulty.16, 17, 18, 19, 20 At the other end of the spectrum of spitzoid lesions, we place “Spitzoid melanomas,” a morphologic type of melanoma with Spitzoid
Congenital nevi
Congenital melanocytic nevi (CMN) are defined as nevi present at birth or appearing within the first year of life. They can be subdivided into 3 groups based on their size: small (<1.5 cm), medium (1.5–20 cm), and large or giant (>20 cm in their projected adult size) (Fig. 6).52 Giant CMN may be further classified as G1 (21–30 cm), G2 (31–40 cm), and G3 (>40 cm). They are genetically determined and persist throughout all life. The estimated prevalence of CMN ranges from 0.5% to 31.7%, depending
Other problematic lesions
The total number of melanocytic nevi varies with age, following a dynamic evolution. Nevus counts and nevus density increase from youth to midlife and thereafter decrease.11 Thus, usually children present with very few nevi, especially if considering children before puberty. Nevi with atypical features generally arise after puberty, representing a marker of increased risk for melanoma development. Therefore, regular follow-up is recommended after puberty, especially in children presenting
Melanoma
Childhood melanoma is extremely rare, accounting for approximately 2% of childhood malignancy. In the United States, 1% to 4% of all melanomas arise in patients younger than 20 years4; however, only 0.3% occur before puberty. In addition to its rarity, childhood melanoma seems to be characterized by different patterns of presentation, risk factors, and survival rates as compared with melanoma of adults. A large retrospective study of children given the diagnosis of melanoma, or ambiguous
Summary
In the great majority of cases, children present with few, banal, nonproblematic melanocytic lesions. Thus, melanoma screening in pediatric patients is not routinely recommended before puberty. After puberty, clinical and dermoscopic follow-up is indicated for those adolescents presenting a higher total nevus count and additional risk factors, such as a family history of melanoma, fair skin phototype, and history of sunburns. In the presence of medium-sized to large or giant congenital nevi,
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Cited by (26)
Perinevic dermatosis neglecta: clinical and dermoscopic description
2019, Anais Brasileiros de DermatologiaSpecial Clinical Situations
2017, Cutaneous Melanoma: a Pocket Guide for Diagnosis and ManagementA meta-analysis of nevus-associated melanoma: Prevalence and practical implications
2017, Journal of the American Academy of DermatologyCitation Excerpt :Studies of patients with melanoma that met the following criteria were included in the analysis: existence of 2 groups of patients with different types of melanoma, namely NAM and DNM. Melanomas associated with medium (>1.5 cm in diameter) and large congenital nevi (>20 cm in diameter) were excluded, when indicated, because the risk of melanoma developing in this context has been estimated to be far higher (up to 10% in some reports) than those of small congenital nevi,15 in which the risk is comparable to acquired melanocytic nevi.16 Two authors (Drs Pampena and Kyrgidis) independently extracted all information by using a standardized data extraction form.
The complex management of atypical Spitz tumours
2016, PathologyCitation Excerpt :The true incidence of atypical Spitz tumours/naevi is not known, although values of 6–8% of the overall number of Spitz naevi have been reported.2 ASTs more commonly develop during the first two decades of life as medium to large (>7 mm in size), nodular, rarely ulcerated, hypopigmented or amelanotic cutaneous lesions (Fig. 1 and 2).4,5 Dermoscopically, a reliable distinction between ASTs and spitzoid melanomas is not feasible5 even if ASTs seem to be more regular in the arrangement of the dermoscopic parameters within the lesion.
Clinical and dermoscopic features of atypical Spitz tumors: A multicenter, retrospective, case-control study
2015, Journal of the American Academy of DermatologyCitation Excerpt :One limitation of our study is that we included only melanocytic lesions (Spitz nevi and atypical Spitz tumors) in the analysis. We did not investigate either the differential diagnosis with Spitzoid melanoma, or nonmelanocytic lesions, such as angioma and pyogenic granuloma, which can simulate atypical Spitz tumors both clinically and dermoscopically.8,10,12,27,28 Further studies are needed to evaluate this differential diagnosis.
Update on melanocytic nevi in children
2015, Clinics in DermatologyCitation Excerpt :Concern about a new or changing melanocytic nevus in a child often prompts parents and pediatricians to request evaluation by a dermatologist. To avoid undue alarm and unnecessary procedures, it is crucial for dermatologists to be aware of the natural history and clinical spectrum of nevi in children, as well as findings that are potentially worrisome in pediatric patients.9–12 This review provides an update on the clinical and dermatoscopic features of melanocytic nevi in children, focusing on their dynamic evolution over time and phenotypic markers (eg, numerous acquired nevi) for increased risk of melanoma in adolescence and adulthood.
The authors have no conflict of interest to declare.
Funding Sources: Study supported in part by the Italian Ministry of Health (RF-2010-2316524).