Change in a child's naevus prompts referral to a dermatology service

Although melanoma is rare in children, parental concern about skin lesions often results in specialist referral and/or excision of benign lesions.

To review dermatology referrals of children with skin lesions to determine reason for referral, macroscopic and dermatoscopic features of referred lesions, diagnosis, management and histology for excised lesions.

Referral letters, clinical and dermatoscopic images and outcomes were reviewed for skin lesions in children aged 0-18 years attending a teledermoscopy clinic over a 28-month period.

Eighty-nine children with 128 lesions accounted for 9% of all referrals to the teledermoscopy clinic. The mean age of the children was 12 years (range 2-18 years). A 'changing mole' was the most common reason for referral (35 children; 39%), followed by 'possible melanoma' (19; 21%), and congenital naevus (9; 10%). The majority of lesions were benign melanocytic naevi (112 lesions; 88%). No lesions were diagnosed as melanoma or non-melanoma skin cancer. A history of change was given for 61/112 lesions (54%). Five lesions were excised; histopathological diagnoses were two spindle cell tumours of Reed, two compound naevi and one Spitz naevus.

Change in a lesion, though a common trigger for referral, is less likely to indicate malignancy in children compared with adults and, as a sole criterion, does not necessitate specialist referral. Teledermoscopy clinics offer high quality macroscopic and dermatoscopic images and can assist in providing reassurance, where appropriate.