Elsevier

Dermatologic Clinics

Volume 31, Issue 4, October 2013, Pages 535-547
Dermatologic Clinics

Problematic Lesions in Children

https://doi.org/10.1016/j.det.2013.06.003Get rights and content

Section snippets

Key points

  • Problematic melanocytic lesions in the pediatric setting are represented by congenital nevi and Spitz nevi.

  • 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.

  • Childhood melanoma often lacks the classical features of pigmented melanoma, and it is more often an amelanotic and nodular lesion resembling pyogenic granuloma or

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,

First page preview

First page preview
Click to open first page preview

References (68)

  • S.W. Kelley et al.

    Sentinel lymph node biopsy as an adjunct to management of histologically difficult to diagnose melanocytic lesions: a proposal

    J Am Acad Dermatol

    (2000)
  • T. Hung et al.

    Sentinel lymph node metastasis is not predictive of poor outcome in patients with problematic spitzoid melanocytic tumors

    Hum Pathol

    (2013)
  • A.A. Marghoob

    Congenital melanocytic nevi. Evaluation and management

    Dermatol Clin

    (2002)
  • S. Seidenari et al.

    Surface microscopy features of congenital nevi

    Clin Dermatol

    (2002)
  • A.R. Rhodes et al.

    Small congenital nevocellular nevi and the risk of cutaneous melanoma

    J Pediatr

    (1982)
  • B.J. Bett

    Large or multiple congenital melanocytic nevi: occurrence of neurocutaneous melanocytosis in 1008 persons

    J Am Acad Dermatol

    (2006)
  • J.N. Kadonaga et al.

    Neurocutaneous melanosis: definition and review of the literature

    J Am Acad Dermatol

    (1991)
  • T. Saida et al.

    Dermoscopy for acral pigmented skin lesions

    Clin Dermatol

    (2002)
  • J.R. Lange et al.

    Melanoma in children: heightened awareness of an uncommon but often curable malignancy

    Pediatrics

    (2005)
  • J.J. Strouse

    Pediatric melanoma: risk factor and survival analysis of the surveillance, epidemiology and end results database

    J Clin Oncol

    (2005)
  • J.V. Schaffer

    Pigmented lesions in children: when to worry

    Curr Opin Pediatr

    (2007)
  • K.M. Cordoro et al.

    Pediatric melanoma: results of a large cohort study and proposal for modified ABCD detection criteria for children

    J Am Acad Dermatol

    (2013)
  • A. Ferrari et al.

    Does melanoma behave differently in younger children than in adults? A retrospective study of 33 cases of childhood melanoma from a single institution

    Pediatrics

    (2005)
  • J.M. Mones et al.

    Melanomas in prepubescent children: review comprehensively, critique historically, criteria diagnostically, and course biologically

    Am J Dermatopathol

    (2003)
  • J.R. Lange et al.

    Melanoma in children and teenagers: an analysis of patients from the National Cancer Data Base

    J Clin Oncol

    (2007)
  • C. Requena et al.

    Spitz nevus: a clinicopathological study of 349 cases

    Am J Dermatopathol

    (2009)
  • E.C. Haliasos et al.

    Dermoscopy for the pediatric dermatologist part III: Dermoscopy of melanocytic lesions

    Pediatr Dermatol

    (2012)
  • E. Moscarella et al.

    Excised melanocytic lesions in children and adolescents—a 10-year survey

    Br J Dermatol

    (2012)
  • S. Spitz

    Melanomas of childhood

    Am J Pathol

    (1948)
  • C. Paniago-Pereira et al.

    Nevus of large spindle and/or epithelioid cells (Spitz's nevus)

    Arch Dermatol

    (1978)
  • P.E. LeBoit

    ‘Safe’ spitz and its alternatives

    Pediatr Dermatol

    (2002)
  • V. Dal Pozzo et al.

    Clinical review of 247 case records of spitz nevus (epithelioid cell and/or spindle cell nevus)

    Dermatology

    (1997)
  • G. Ferrara et al.

    Spitz nevus: an evolving clinicopathologic concept

    Am J Dermatopathol

    (2010)
  • G. Ferrara et al.

    Melanocytic tumors of uncertain malignant potential in childhood: do we really need sentinel node biopsy?

    J Cutan Pathol

    (2012)
  • Cited by (26)

    • Special Clinical Situations

      2017, Cutaneous Melanoma: a Pocket Guide for Diagnosis and Management
    • A meta-analysis of nevus-associated melanoma: Prevalence and practical implications

      2017, Journal of the American Academy of Dermatology
      Citation 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, Pathology
      Citation 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 Dermatology
      Citation 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 Dermatology
      Citation 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.

    View all citing articles on Scopus

    The authors have no conflict of interest to declare.

    Funding Sources: Study supported in part by the Italian Ministry of Health (RF-2010-2316524).

    View full text