Update on melanocytic nevi in children
Section snippets
Epidemiology and overview
Melanocytic nevi are an almost ubiquitous finding in pediatric patients.1 By the end of the first decade of life, nevus counts reach a mean of 15 to more than 30 in white children and 5 to 10 in those of African, Asian, or Native American heritage.[2], [3] The number of nevi typically peaks in the third decade, subsequently decreasing with age. In stark contrast, melanoma is extremely rare during childhood but becomes progressively more common with age, with a peak in the seventh decade of life.
Acquired nevi in childhood and adolescence: growing moles in growing patients
During the past decade, multiple studies have emphasized that melanocytic nevi in children and adolescents have morphologic features and behavior that differ from nevi in adults. On dermatoscopic evaluation, a globular pattern predominates among acquired nevi in children as well as CMN, especially for lesions located on the head, neck, and upper part of the trunk.[13], [14], [15], [16], [17] In contrast, a reticular pattern is more common for acquired nevi that develop in adulthood or are
Environmental and genetic factors in nevus development
Sun exposure, especially when intense and intermittent, represents the primary environmental influence on the number and location of nevi that develop during childhood as well as later risk of melanoma.30 White children living in a tropical climate tend to develop a higher peak nevus number at an earlier age (eg, mean peak of ~ 50 nevi at age 15 years) than those residing in a temperate location (eg, mean peak of ~ 25 nevi at age 25 years). Sunscreen use can be protective against nevus
Managing the “moley” child
Nevus phenotype manifests gradually during the first decade of life, with the predisposition to a high nevus count generally becoming apparent by 11 or 12 years of age.44 Atypical nevi usually begin to appear around puberty and continue to develop during adulthood.45 They represent benign acquired melanocytic nevi that share, usually to a lesser degree, some of the clinical features of melanoma (ie, asymmetry, border irregularities/fuzziness, color variegation, and diameter > 6 mm). An increased
Site-related considerations for nevi in children
Melanocytic nevi in certain anatomic locations (eg, the scalp, genital area, and hands/feet) have traditionally led to increased concern among parents and physicians. Underlying factors for this heightened alarm have included differences in the clinical appearance of the lesions, challenges in monitoring, and a higher likelihood of atypical histologic findings.59 However, recent evidence has accumulated that nevi in these “special sites” in children and adolescents do not exhibit worrisome
Insights into the natural history of Spitz nevi
A Spitz (spindle and epithelioid cell) nevus is a distinct type of benign melanocytic neoplasm that most commonly develops in children. In several large series, approximately 50% to 75% of patients with lesions diagnosed histologically as Spitz nevi were younger than 20 years of age.[77], [78], [79], [80] A Spitz nevus classically presents as a solitary pink, red, or brown papule, most often on the face (especially in young children) or lower extremity (Figure 3). Initial growth tends to be
Evolving definitions and concepts of CMN
The size-based classification of CMN was standardized and updated in 2012,116 with refinement of the giant category that accounts for the majority of melanomas observed in large studies (see later). This system divides CMN into four groups based on the largest expected adult diameter, in centimeters: (1) small, < 1.5; (2) medium (M1: 1.5-10, M2: > 10-20); (3) large (L1: > 20-30, L2: > 30-40); (4) giant (G1: > 40-60, G2: > 60). Because CMN typically enlarge in proportion to the child’s growth, the
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Genodermatoses associated with melanocytic nevi
2022, Clinics in DermatologyCitation Excerpt :While melanocytic nevi are present in almost all individuals and are commonly associated with environmental factors such as sun exposure, they can also can be important features of genetic syndromes.1
Melanocytic tumors
2022, Medicine (Spain)Cells to Surgery Quiz: December 2021
2021, Journal of Investigative DermatologySpitz Nevus: Review and Update
2021, Clinics in Plastic SurgeryCitation Excerpt :Adulthood Spitz nevi tend to affect young women more than men.3 The age of those diagnosed with Spitz nevus typically ranges from 1 to 61 years, with a mean age of 22 years4,5; however, congenital Spitz nevi have been reported.6 In comparison, spitzoid malignant melanoma has a mean age at diagnosis of 55 years, ranging from 8 to 90 years.5
Pathology of Melanoma
2020, Surgical Clinics of North AmericaCitation Excerpt :They can develop in both children and adults. Those that appear before puberty show clinical features and evolution similar to small and moderate-sized CMN.9 Acquired nevi also are associated with an increased risk of melanoma, especially when associated with increased number, atypical features, and ultraviolet light exposure.19