Is Pediatric Melanoma Really That Different from Adult Melanoma? A Multicenter Epidemiological, Clinical and Dermoscopic Study

Abstract

Purpose: To improve the diagnostic accuracy and optimal management of pediatric melanomas.

Methods: We conducted a retrospective descriptive, multicenter study of the epidemiological, clinical, and dermoscopic characteristics of histopathologically proven melanomas diagnosed in patients less than 18 years old. Data on sociodemographic variables, clinical and dermoscopic characteristics, histopathology, local extension, therapy and follow-up, lymph node staging, and outcome were collected from the databases of three Italian dermatology units. We performed a clinical evaluation of the morphological characteristics of each assessed melanoma, using both classic ABCDE criteria and the modified ABCDE algorithm for pediatric melanoma to evaluate which of the two algorithms best suited our series.

Results: The study population consisted of 39 patients with a histologically confirmed diagnosis of pediatric melanoma. Comparing classic ABCDE criteria with the modified ABCDE algorithm for pediatric melanomas, the modified pediatric ABCDE algorithm was less sensitive than the conventional criteria. Dermoscopically, the most frequent finding was the presence of irregular streaks/pseudopods (74.4%). When evaluating the total number of different suspicious dermoscopy criteria per lesion, 64.1% of the lesion assessments recognized two dermoscopic characteristics, 20.5% identified three, and 15.4% documented four or more assessments.

Conclusions: Contrary to what has always been described in the literature, from a clinical point of view, about 95% of our cases presented in a pigmented and non-amelanotic form, and these data must be underlined in the various prevention campaigns where pediatric melanoma is currently associated with a more frequently amelanotic form. All the pediatric melanomas analyzed presented at least two dermoscopic criteria of melanoma, suggesting that this could be a key for the dermoscopic diagnosis of suspected pediatric melanoma, making it possible to reach an early diagnosis even in this age group.

Keywords: children; dermoscopy; estrogen; melanoma; skin cancer.

Figure 1

Comparison between pediatric and adult ABCDE algorithms. The classic ABCDE algorithm was the one that best suited our cases (69.2% of lesions were asymmetric, edges were irregular in 64.1% of cases, 59.0% of our PM cases presented clinically with two or more colors, and 56.4% were over 6 mm in diameter).

Figure 2

Clinical and dermoscopic images of PM (rulers are in millimeters). (A,B) Deep penetrating melanoma (1.9 mm Breslow thickness) of the back in a nine-year-old boy: (A) Clinical presentation. (B) Dermoscopy reveals irregular streaks and a blue–white veil. (C,D) Reed-like spindle cell melanoma of the left ankle in situ in an 18-year-old female: (C) Clinical presentation. (D) Dermoscopy reveals a multicomponent pattern with inverse network and irregular streaks/pseudopods. (E,F) Hypomelanotic nevoid melanoma (1.2 mm Breslow thickness) of the back on a 14-year-old girl: (E) Clinical presentation. (F) Dermoscopy reveals a pinkish background and an atypical vascular pattern with polymorphic vessels. In the superior part of the lesion, the atypical pigment network is detectable.

Figure 3

(A,B) Superficial spreading melanoma developed within a medium-sized congenital melanocytic nevi in a female 18-year-old patient: (A) Clinical presentation (ruler is in millimeters): an achromic papillomatous neoformation can be observed in the context of the nevus. (B) Dermoscopy atypical and aspecific vascular pattern within the growing achromic lesions.