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Melanomas in Prepubescent Children: Review Comprehensively, Critique Historically, Criteria Diagnostically, and Course Biologically

Mones, Joan M. D.O.; Ackerman, A. Bernard M.D.

Section Editor(s): Ackerman, A. Bernard Editor

The American Journal of Dermatopathology: June 2003 - Volume 25 - Issue 3 - p 223-238
From Dermatopathology: Practical and Conceptual

Our series was comprised of 11 children age 10 years or younger (6 were younger than age 5) with primary cutaneous melanoma. All of the melanomas occurred de novo and all metastasized; one child died. In no instance was melanoma a clinical consideration, and in none did the histopathologist who first “signed out” the case make a diagnosis of melanoma. Despite the inability of clinicians and pathologists to diagnose correctly, with repeatability, melanomas that develop in children yet to be pubescent, those neoplasms, nonetheless, are melanomas and, therefore, criteria employed currently for diagnosis of melanoma, especially clinically, must be refined in order that they be applicable equally to melanomas in pre- and postpubescents. The vaunted ABCDs (Asymmetry, Border irregular, Color variability, Diameter >6.0mm) surely do not work for melanomas that appear in children who are prepubescent. Additionally, melanomas that occur in these children have distinctly different architectural and cytopathological features from those that arise in postpubescents, often being confused as they are by conventional microscopy with a Spitz's nevus. As a rule, melanomas in prepubescent children grow much more rapidly then those in adults but, like them, have the capability to disseminate widely and cause death.

Dr. Mones is an Associate at the Ackerman Academy of Dermatopathology in New York City where Dr. Ackerman is Director.

Address correspondence to J.M. Mones, D.O., 145 East 32nd Street, 10th Floor, New York, NY 10016. E-mail:

Adapted from Dermatopathology: Practical and Conceptual 2002;8:1 ( Ardor Scribendi, Ltd. All rights reserved.

Throughout this work, the word “melanoma,” unmodified, is synonymous with malignant melanoma, and the word “nevus,” unmodified, is synonymous with melanocytic nevus.

© 2003 Lippincott Williams & Wilkins, Inc.