Which pigmented moles should be removed in prepubertal-age children? A case for a conservative approach

It is generally acknowledged that malignant melanoma is very rare in children before puberty, but recommendations for the treatment of pigmented moles often seem to discount this information. To document the frequency of malignant melanoma in Australian children of prepubertal age, several methods were used. These attempts showed the difficulty in obtaining completely valid figures, but sufficient information was collected to confirm the extreme rarity of malignant melanoma in this age group. It is, therefore, suggested that prophylactic removal of pigmented moles is generally not indicated in children before puberty, and that removal of a pigmented mole because of the possibility that malignant melanoma has developed should rarely be necessary in this age group. This information may help to reduce the concern that is often expressed about pigmented lesions in children, and to prevent unnecessary surgery.