Clinical and dermoscopic characterization of pediatric and adolescent melanomas: Multicenter study of 52 cases

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Abstract

Background

Knowledge regarding the morphologic spectrum of pediatric melanoma (PM) is sparse, and this may in part contribute to delay in detection and thicker tumors.

Objective

To analyze the clinicodermoscopic characteristics of PM.

Methods

Retrospective study of 52 melanomas diagnosed in patients before the age of 20 years.

Results

On the basis of its clinical, dermoscopic, and histopathologic characteristics, PM can be classified as spitzoid or nonspitzoid. The nonspitzoid melanomas (n = 37 [72.3%]) presented in patients with a mean age of 16.3 years (range, 8-20) and were associated with a high-risk phenotype and a pre-existing nevus (62.2%). The spitzoid melanomas (n = 15 [27.7%]) were diagnosed in patients at a mean age of 12.5 years (range, 2-19) and were mostly de novo lesions (73.3%) located on the limbs (73.3%). Whereas less than 25% of PMs fulfilled the modified clinical ABCD criteria (amelanotic, bleeding bump, color uniformity, de novo at any diameter), 40% of spitzoid melanomas did. Dermoscopic melanoma criteria were found in all cases. Nonspitzoid melanomas tended to be multicomponent (58.3%) or have nevus-like (25%) dermoscopic patterns. Spitzoid melanomas revealed atypical vascular patterns with shiny white lines (46.2%) or an atypical pigmented spitzoid pattern (30.8%). There was good correlation between spitzoid subtype histopathologically and dermoscopically (κ = 0.66).

Limitations

A retrospective study without re-review of pathologic findings.

Conclusion

Dermoscopy in addition to conventional and modified clinical ABCD criteria helps in detecting PM. Dermoscopy assists in differentiating spitzoid from nonspitzoid melanomas.

Graphical abstract

Schematics with the main dermoscopic features of the 4 patterns. Dermoscopic patterns found in pediatric melanoma: Pattern 1, Multicomponent pattern, mostly found in non-Spitzoid melanomas associated with nevus. Asymmetric polychromic multicomponent pattern, with irregular globules, negative network and structureless areas and some regression features. Pattern 2, Nevus-like; only found in adolescents with non-Spitzoid melanomas. Symmetric 1 or 2 patterns, with a few melanoma local features. Pattern 3, Pink vascular Spitzoid pattern. Polymorphic vascular pattern and shiny white structures. Pattern 4, Atypical pigmented Spitzoid pattern. Asymmetrical distributed starburst or globular pattern with pseudopods at the periphery.

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