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Published on: May 18, 2018
Infantile melanoma--a triple threat: diagnosis and management
Milena Lambie1, Chad Nadler, Paul Glat
1Department of Plastic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA.
Insights
Infantile melanoma, though rare, is increasing. Early diagnosis and multidisciplinary management are crucial for these challenging pediatric cases to improve outcomes.
Area of Science:
- Pediatric Oncology
- Dermatology
- Pathology
Background:
- Infantile melanoma is exceptionally rare, with limited literature.
- Pediatric melanoma presents diagnostic and therapeutic challenges, including delayed diagnosis, thick lesions, metastatic risk, and uncertainty in pathology and management.
- While uncommon, childhood melanoma, particularly in infants, appears to be increasing.
Observation:
- Presents two cases of infantile melanoma diagnosed before one year of age.
- One case involved melanoma arising in a congenital melanocytic nevus; the other presented as a de novo scalp lesion.
- Both cases required multidisciplinary management.
Findings:
- Infantile melanoma diagnosis is often delayed, leading to thicker lesions.
- Histologic diagnosis can be uncertain in this age group.
- Lack of established guidelines for regional node management and adjuvant therapy complicates treatment.
Implications:
- Highlights the need for increased awareness and early detection of infantile melanoma.
- Emphasizes the importance of multidisciplinary teams for optimal staging and treatment.
- Underscores the need for further research to guide management and improve outcomes for pediatric melanoma patients.
Abstract:
Cases of infantile melanoma are very rare, and only a few have been presented in the literature. Pediatric melanoma can present to the clinician as a "triple threat" of delayed diagnosis resulting in thick lesions at risk for metastasis, histologic uncertainty of diagnosis, and a lack of data guiding regional node management and adjuvant therapy. Melanoma in childhood is an uncommon condition, and it is even more atypical in infants. There is evidence however that it is increasing in frequency. We present 2 cases of infantile melanoma diagnosed before age 1 and multidisciplinary management performed at our institution. One child was diagnosed with melanoma arising within a congenital melanocytic nevus, and the other presented with melanoma from a de novo acquired scalp lesion. The ambiguity surrounding correct pathologic diagnosis of melanoma in this age group, and the tendency for late diagnosis with thicker lesions presents special staging and treatment challenges to the team of specialists involved in the care of these children.
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