CHILDHOOD MELANOMA - A CLINICOPATHOLOGICAL STUDY OF 22 CASES

Childhood melanoma is a rare disease with an estimated incidence of on e per million per year. Careful study of childhood melanoma patients i s critical due to the limited data currently available pertaining to t his disease. Twenty-two children 15 years of age or under with maligna nt melanoma were treated at the Pigmented Lesion Clinic of Massachuset ts General Hospital over a 33-year period. The medical records of all patients were reviewed, as well as the histologic characteristics of t he lesions. Patients who were initially diagnosed with malignant melan oma but on review found to have Spitz naevi were not included in our s tudy. Ten patients were boys and 12 were girls. The median ages of the boys and girls in our study were 12.9 and 13.6 years, respectively. A mong the classified primary melanomas, 10 were superficial spreading, three were borderline/minimal deviation, two were nodular and one was melanoma in situ. Four of 22 patients had a documented family history of melanoma, and two additional patients had a family history of dyspl astic naevi. A majority of lesions (14/22) arose in association with a precursor lesion, Two children died of disease at 1 and at 7 years fo llowing initial diagnosis. Eight patients had documented metastases. S ince the majority of melanomas arose in association with a precursor l esion, follow-up of children with congenital and/or dysplastic naevi i s recommended. An interesting finding was the sometimes paradoxical be haviour of relatively thin lesions with metastases. Thus, a high index of suspicion is needed by the clinician confronted with melanocytic l esions of childhood. We found children from age 12 to 15 to be more at risk for the development of melanoma than younger children. Melanoma presenting before the age of 10 is very unusual.