Review
Pediatric melanomas and the atypical spitzoid melanocytic neoplasms

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Abstract

Cutaneous malignancies in the pediatric population are rare. Melanocytic neoplasms have garnered increased attention as the incidence of melanoma rises and as published analyses of biologically indeterminate lesions become more commonplace. Pediatric melanomas have been studied in several large cohort series; still, most of our assumptions for treatment stems from research in the adult population. Many clinicians speculate that pediatric melanomas may be biologically different from the same histological entity in adults given observed differences in metastatic potential and overall outcomes in children. Even more confounding are the atypical spitzoid lesions, which continue to spark debate in the oncology and dermatopathology literature with respect to classification, malignant potential, and recommended treatment course. In this article, recent literature addressing both atypical spitzoid melanocytic neoplasms and melanoma in the pediatric population is discussed.

Section snippets

A historical perspective

Sophie Spitz first differentiated the Spitz nevus from “juvenile melanoma” in 1948, and since that time the term spitzoid has been used to characterize melanocytic neoplasms with spindle and epithelioid features.8 Further classification of lesions with spitzoid features remains the subject of much debate within the dermatopathology literature. The greatest challenge stems from the lack of a reliable diagnostic test as it relates to biological behavior and thereby clinical significance.

The

Epidemiology

Melanoma accounts for 1% to 3% of all pediatric malignancies.52 The US Surveillance, Epidemiology and End Results Program reports that between 300 and 420 new pediatric melanomas are diagnosed each year.53 The incidence of pediatric melanoma in the United States appears to have increased from 1973 to 2001 at a rate of 2.9% per year and 46% per year of age.54, 55

There is an apparent female predominance, and the incidence of pediatric melanoma appears to increase with increasing age. A review of

Conclusions

Both atypical spitzoid melanocytic neoplasms and pediatric melanoma are rare tumors seen in the pediatric population. Although the exact classification and biology of ASMN remains controversial, clinicians today recognize that there is a rare but real malignant potential for ASMN. Unfortunately, the true extent and risk of metastases from these lesions continues to be ambiguous. Correct diagnosis is paramount because treatment and prognosis differ. Based on our current knowledge, wide local

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