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Updated: Jun 21, 2026
A Melanoma Patient-Derived Xenograft Model
Published on: May 20, 2019
Pediatric melanoma: a single-institution experience of 150 patients
Jennifer H Aldrink1, M Angelica Selim, Diana L Diesen
1Department of Surgery, Duke University Medical Center, Durham, NC, USA. jennifer.aldrink@nationwidechildrens.org
Purpose:
Differentiating pigmented skin lesions from malignant melanoma in the pediatric population has been a challenge. Despite guidelines describing clinical features and histopathologic criteria to distinguish these lesions, misdiagnoses still occur. We report our experience over 30 years in a pediatric population with malignant melanoma.
Methods:
We performed a retrospective review of 150 pediatric patients treated for malignant melanoma between 1973 and 2007 at our institution. Outcomes measured included age, Breslow thickness, Clark level of invasion, tumor location, local and distant failure rates, and overall survival.
Results:
One hundred fifty pediatric patients were evaluated. The mean age was 15.1 years. The mean Breslow thickness was 2.05 mm and corresponding Clark level of invasion was 3.47. There were 43 known recurrences (29%); 29 distant, 14 nodal, and 7 local. Overall survival was 84% with a mean follow-up of 8.5 years. Sixteen patients (10.7%) were incorrectly diagnosed on initial pathologic examination. Overall survival in the misdiagnosed group was 66%.
Conclusion:
Pigmented skin lesions in the pediatric population represent a diagnostic challenge to pathologists and clinicians. Improvements in diagnostic techniques with rigorous characterization, as well as increased physician awareness, should lead to a reduction in errors of diagnosis.
Insights
Diagnosing pediatric malignant melanoma is challenging, with 10.7% of cases initially misdiagnosed. Improved diagnostic techniques and physician awareness are crucial for reducing errors in pigmented skin lesion assessment.
Area of Science:
- Pediatric Oncology
- Dermatopathology
- Surgical Pathology
Background:
- Differentiating benign pigmented skin lesions from malignant melanoma in children presents diagnostic difficulties.
- Despite established guidelines, misdiagnoses of pediatric melanoma occur, impacting patient outcomes.
Purpose of the Study:
- To review a 30-year experience with malignant melanoma in a pediatric population.
- To analyze outcomes including survival rates and diagnostic accuracy.
Main Methods:
- Retrospective review of 150 pediatric patients diagnosed with malignant melanoma (1973-2007).
- Evaluation of patient age, tumor characteristics (Breslow thickness, Clark level), location, recurrence rates, and survival.
- Analysis of initial diagnostic errors through pathologic examination.
Main Results:
- The study included 150 pediatric patients with a mean age of 15.1 years.
- Mean Breslow thickness was 2.05 mm with a mean Clark level of 3.47.
- Overall survival was 84%, but 10.7% of patients had initial diagnostic errors, with a significantly lower survival rate (66%) in this subgroup.
Conclusions:
- Pigmented skin lesions in children pose a significant diagnostic challenge for clinicians and pathologists.
- Enhanced diagnostic accuracy through improved techniques and increased physician awareness is essential to minimize misdiagnosis rates.
- Reducing diagnostic errors is critical for improving overall survival in pediatric melanoma patients.
