To the Editor:
I read with great interest the study on melanomas in prepubescent children: “Review Comprehensively, Critique Historically, Criteria Diagnostically, and Course Biologically” with its superb photographs by Mones and Ackerman. 1 It is a retrospective study in which the metastatic disease established the diagnosis. It seems that routine histology has reached its limits in these types of lesions, and an effort should be made to seek other means to establish the correct diagnosis. The use of adjunctive means, especially immunohistochemistry and cytogenetics, is increasingly used in tumor pathology, and we should consider them in melanoma diagnosis as well. Adjunct techniques such as nuclear morphometry, 2 Ki-67 staining, 3 AgNOR counting, 4 and comparative genomic hybridization 5 have shown promising results in the differential diagnosis of benign from malignant melanocytic lesions. Although these techniques are far from being “ideal” and lack absolute sensitivity or specificity, they may be considered as candidates to be added to the classical histologic criteria, which are far from being ideal themselves. Alternatively, some of these adjunctive means may be used as a “red buzzer” to the dermatopathologist when he is vacillating between malignant melanoma and a Spitz nevus. It would be interesting to test some of these potential adjunctive means in the cases studied by Mones and Ackerman.
Reuven Bergman, MD
1. Mones JM, Ackerman AB. Melanomas in prepubescent children: review comprehensively, critique historically, criteria diagnostically, and course biologically. Am J Dermatopathol. 2003; 25:223–238.
2. Bergman R, Sabo E, Schafer I. Measurement of the maturation parameter by using computer-assisted interactive image analysis may be helpful in the differential diagnosis between compound Spitz nevus and malignant melanoma. Am J Dermatopathol. 1996; 18:567–570.
3. Bergman R, Malkin L, Sabo E, et al. MIB-1 monoclonal antibody to determine proliferative activity of Ki-67 antigen as an adjunct to the histopathologic differential diagnosis of Spitz nevi. J Am Acad Dermatol. 2001; 44:500–504.
4. Ling-Xi LL, Crotty KA, Palmer AA, et al. Argyrophilic staining of nucleolar organizer region count and morphometry in benign and malignant melanocytic lesions. Am J Dermatopathol. 2003; 25:190–197.
5. Bastian BC. Molecular cytogenetics as a diagnostic tool for typing melanocytic tumors. Recent Results Cancer Res. 2003; 160:92–99.