Atypical Presentation of Malignant Melanoma in a 16 Months Old Child

Liv Schoellhammer^1, , Torben Stamm Mikkelsen², Henrik Schmidt³ and Lene Birk-Soerensen¹

¹Department of Plastic surgery, Aalborg University Hospital, 9000 Aalborg Denmark

²Department of Pediatrics, Herning Hospital, 7400 Herning, Denmark

³Department of Oncology, Aarhus University Hospital, 8200 Aarhus N, Denmark

Cite this paper

Liv Schoellhammer, Torben Stamm Mikkelsen, Henrik Schmidt and Lene Birk-Soerensen. Atypical Presentation of Malignant Melanoma in a 16 Months Old Child. American Journal of Medical Case Reports. 2015; 3(3):79-81. doi: 10.12691/AJMCR-3-3-7

Abstract

Malignant melanoma in childhood and adolescence is rare but incidences have been seen to rise. Prognostic factors, risk factors and prognosis have similarities to melanoma in adulthood but paediatric melanoma presents a diagnostic challenge as it often lacks the classical features of adult pigmented malignant melanoma and histologically is difficult to diagnose. This case report describes a clinically atypical presentation of melanoma on the thigh of a 16 month old boy. Initially seen at five months old by a dermatologist were a punch biopsy of the element was made with histological diagnosis; unusual congenital nevus. The element hereafter evolved and at the time of diagnosis measured 7.5 mm in Breslow thickness. Sentinel node biopsy and full body scans were made with no sign of metastasis. Like other cases reported, the melanoma did not exhibit the classical characteristics of the ABCD criteria which may have played a part in delaying diagnosis. Studies suggest that delayed diagnosis in children is not uncommon and younger patients present with more advanced disease at the time of diagnosis. To facilitate earlier recognition of melanoma in children additions to the conventional ABCD criteria have been suggested. This report illustrates that malignant melanoma should always be taken into consideration when presented with lesions of the skin and that a high level of clinical awareness and suspicion is required in order to hasten diagnosis and maybe improve prognosis in cutaneous malignant melanoma in children and adolescents.

Keywords

melanoma, nevus, pigmented, child, dermatology, adolescent

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Jen M, Murphy M, Grant-Kels JM. Childhood melanoma. Clin Dermatol 2009 November; 27 (6): 529-36.
[2]	Pappo AS. Melanoma in children and adolescents. Eur J Cancer 2003 December; 39 (18): 2651-61.
[3]	Hamre MR, Chuba P, Bakhshi S, Thomas R, Severson RK. Cutaneous melanoma in childhood and adolescence. Pediatr Hematol Oncol 2002 July; 19 (5): 309-17.
[4]	Strouse JJ, Fears TR, Tucker MA, Wayne AS. Pediatric melanoma: risk factor and survival analysis of the surveillance, epidemiology and end results database. J Clin Oncol 2005 July 20; 23 (21): 4735-41.
[5]	Wong JR, Harris JK, Rodriguez-Galindo C, Johnson KJ. Incidence of childhood and adolescent melanoma in the United States: 1973-2009. Pediatrics 2013 May; 131 (5): 846-54.
[6]	Karlsson PM, Fredrikson M. Cutaneous malignant melanoma in children and adolescents in Sweden, 1993-2002: the increasing trend is broken. Int J Cancer 2007 July 15; 121 (2): 323-8.
[7]	Brenn T, McKee PH. Melanoma in children and adolescents. Diagnostic Histopathology 2008 January 21; 14 (1).
[8]	Han D, Zager JS, Han G, Marzban SS, Puleo CA, Sarnaik AA, Reed D, Messina JL, Sondak VK. The unique clinical characteristics of melanoma diagnosed in children. Ann Surg Oncol 2012 November; 19 (12): 3888-95.
[9]	Averbook BJ, Lee SJ, Delman KA, Gow KW, Zager JS, Sondak VK, Messina JL, Sabel MS, Pittelkow MR, Ecker PM, Markovic SN, Swetter SM, Leachman SA, Testori A, Curiel-Lewandrowski C, Go RS, Jukic DM, Kirkwood JM. Pediatric melanoma: analysis of an international registry. Cancer 2013 November 15; 119 (22): 4012-9.
[10]	Cordoro KM, Gupta D, Frieden IJ, McCalmont T, Kashani-Sabet M. Pediatric melanoma: results of a large cohort study and proposal for modified ABCD detection criteria for children. J Am Acad Dermatol 2013 June; 68 (6): 913-25.
[11]	Moscarella E, Piccolo V, Argenziano G, Lallas A, Longo C, Castagnetti F, Pizzigoni S, Zalaudek I. Problematic lesions in children. Dermatol Clin 2013 October; 31 (4): 535-47, vii.
[12]	Abbasi NR, Shaw HM, Rigel DS, Friedman RJ, McCarthy WH, Osman I, Kopf AW, Polsky D. Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria. JAMA 2004 December 8; 292 (22): 2771-6.