Clinical and dermoscopic characterization of pediatric and adolescent melanomas: Multicenter study of 52 cases

Abstract

Background: Knowledge regarding the morphologic spectrum of pediatric melanoma (PM) is sparse, and this may in part contribute to delay in detection and thicker tumors.

Objective: To analyze the clinicodermoscopic characteristics of PM.

Methods: Retrospective study of 52 melanomas diagnosed in patients before the age of 20 years.

Results: On the basis of its clinical, dermoscopic, and histopathologic characteristics, PM can be classified as spitzoid or nonspitzoid. The nonspitzoid melanomas (n = 37 [72.3%]) presented in patients with a mean age of 16.3 years (range, 8-20) and were associated with a high-risk phenotype and a pre-existing nevus (62.2%). The spitzoid melanomas (n = 15 [27.7%]) were diagnosed in patients at a mean age of 12.5 years (range, 2-19) and were mostly de novo lesions (73.3%) located on the limbs (73.3%). Whereas less than 25% of PMs fulfilled the modified clinical ABCD criteria (amelanotic, bleeding bump, color uniformity, de novo at any diameter), 40% of spitzoid melanomas did. Dermoscopic melanoma criteria were found in all cases. Nonspitzoid melanomas tended to be multicomponent (58.3%) or have nevus-like (25%) dermoscopic patterns. Spitzoid melanomas revealed atypical vascular patterns with shiny white lines (46.2%) or an atypical pigmented spitzoid pattern (30.8%). There was good correlation between spitzoid subtype histopathologically and dermoscopically (κ = 0.66).

Limitations: A retrospective study without re-review of pathologic findings.

Conclusion: Dermoscopy in addition to conventional and modified clinical ABCD criteria helps in detecting PM. Dermoscopy assists in differentiating spitzoid from nonspitzoid melanomas.

Keywords: Spitz; childhood; dermoscopy; detection; melanoma; pediatric melanoma; spitzoid.

Figure 1.. Pattern 1, Multicomponent pattern. Non-Spitzoid melanomas in adolescents.

a) Clinically, symmetric 6mm pigmented lesion on the upper limb of 18yo girl. b) Dermoscopy: Asymmetric polychromic (white, blue-grey, light and dark brown) multicomponent pattern, with irregular globules, negative network and structureless white regression central area. Melanoma arising in a nevus, Breslow 0.4mm. c) Clinically, asymmetric 12mm lesion on the back of a 13year old girl affected by multiple atypical nevi and familial melanoma. d) Dermoscopy: Asymmetric multicomponent polychromic pattern, irregular globules and negative network and focal bluegrey regression. Melanoma arising in a nevus, Breslow 0.3mm. e) Clinically symmetric pigmented lesion on the trunk of 14 year old girl presenting multiple nevi. f) Dermoscopy: asymmetric multicomponent pattern, with network, irregular globules, islands of negative network and structureless areas. Superficial spreading Melanoma, Breslow 0.7mm.

Figure 2.. Pattern 2, Nevus-like. Non-Spitzoid melanomas in adolescents.

a) Clinically, symmetric 5mm lesion on a 19 year old boy. b) Dermoscopy: Symmetric globular pattern, with structureless central black area. Superficial spreading Melanoma, Breslow 0.6mm. c) Clinically, symmetric light brown macule on the chest of a 17year old boy affected by multiple atypical nevi and previous melanoma. d) Dermoscopy: Symmetric light brown lesion showing irregular globules and negative network. Melanoma arising in a nevus, Breslow 1.0mm. e) Clinically asymmetric lesion on the trunk of a 19 year old boy. f) Dermoscopy: symmetric reticular-globular pattern, with atypical network, irregular pigmented globules and dots at the periphery and central blue-white veil. Melanoma arising in a nevus, Breslow 3.1mm.

Figure 3.. Pattern 3, Pink vascular Spitzoid pattern.

a) Clinically, hypomelanotic rapid growing tumor on a 14 year old girl. b) Dermoscopy: Polymorphic vascular pattern, with dotted vessels, milky red areas and remnants of pigment at the periphery, central shiny white structures. Spitzoid melanoma, Breslow 1.9 mm. c) Clinically, amelanotic pink bump on the lower limb of a 3 year old girl. d) Dermoscopy: Polymorphic vascular pattern, milky red areas and globules and shiny white structures. Spitzoid melanoma Breslow 5.5 mm e) Clinically ulcerated amelanotic bump on the lower limb of a 17 year old girl. f) Dermoscopy: Vascular pattern showing dotted vessels and milky red globules, and ulceration. Spitzoid melanoma, Breslow 1.9 mm.

Figure 4.. Pattern 4, Pigmented Spitzoid pattern.

a) Clinically, asymmetric polychromic lesion on the finger of a 4 year old boy. b) Dermoscopy: Multicomponent pattern on acral site, showing Spitzoid features with peripheral streaks, blue white veil in the center and multiple irregular black globules and dots. Spitzoid melanoma, Breslow 2.8 mm. c) Clinically, symmetric pigmented tumor on the lower limb of a 9 year old boy. d) Dermoscopy: Asymmetric globular pattern with ulceration, blue white veil and irregular black dots. Invasive Spitzoid melanoma e) Clinically pigmented lesion on the lower limb of a 17 year old girl. f) Dermoscopy: Asymmetric pigmented Spitzoid pattern, with irregular pseudopods, blue white veil, shiny white structures. Spitzoid melanoma, Breslow 0.42 mm.