Dr. Bergman seems to have misunderstood the message of our piece concerning “Melanomas in Prepubescent Children” (Am J Dermatopathol. 2003;25(3):223–238). The diagnosis in our 11 children 10 years of age or younger was not “established” by metastasis; it was confirmed by it. The diagnosis histopathologically was established by application scrupulously of criteria based on findings in sections of tissue, ones that we aver are more effective in distinguishing those melanomas from Spitz's nevi (termed “juvenile melanomas” by Spitz herself).
We gave credence in our article to the concept of a malignant neoplasm of melanocytes being distinguishable from a benign neoplasm of melanocytes in sections prepared routinely and examined by conventional microscopy in these words:
“Despite many findings in common with Spitz's nevus (Table 4), there are major differences in architectural pattern and in cytopathologic features between melanoma in prepubescents and Spitz's nevus (Table 4), there are major differences in architectural pattern and in cytopathologic features between melanoma in prepubescents and in Spitz's nevus (Table 5). At scanning magnification, the silhouette of each of the melanomas in our series is distinctive, different from melanomas seen usually in postpubescents, the chief attributes of it being vertical orientation, diffuse infiltration throughout the dermis, and involvement, often extensively, of the subcutaneous fat (Table 5). By applying criteria established for differentiation histopathologically of melanoma from Spitz's nevi in patients of any age, an accurate diagnosis of melanoma in a child can be rendered.”
If Dr. Bergman would be interested in testing some “potential adjunctive means” in specimens of melanomas in prepubescents studied by us, we would be pleased to arrange that.
Joan M. Mones, DO
Bernard Ackerman, MD