Pediatric melanomas often mimic benign skin lesions: A retrospective study

Area of Science:

• Dermatology
• Pediatric Oncology

Background:

• Childhood melanoma is rare and often presents atypically, leading to misdiagnosis.
• Dermatologists and other physicians may struggle to identify pediatric melanoma due to its presentation.

Purpose of the Study:

• To correlate the clinical appearance of pediatric melanomas with Breslow depth and clinical behavior.
• To identify diagnostic errors in pediatric melanoma cases.

Main Methods:

• Retrospective review of medical records for patients 21 years or younger diagnosed with primary cutaneous melanoma.
• Data collected from January 2000 to January 2015 at Mayo Clinic.

Main Results:

• Melanomas mimicking benign lesions were significantly deeper (>1 mm) and had higher T stage (T2-T4).
• 66% of pediatric melanomas initially diagnosed as benign melanocytic lesions showed changes in size, shape, and color.
• Clinical appearance significantly correlated with Breslow depth and T stage.

Conclusions:

• Benign-appearing pediatric lesions with a history of evolution, bleeding, or ulceration should raise suspicion for melanoma.
• Melanomas with these concerning features are associated with increased Breslow depth and T stage.
• While not all changing lesions require biopsy, close monitoring is recommended for pediatric skin lesions exhibiting changes.