Pediatric Melanoma Diagnosis Aided By Use of Dermoscopy, ABCD Criteria

A dermatologist examining child's skin
A dermatologist examining child’s skin
The addition of dermoscopy to the diagnostic work-up allows for differentiation between spitzoid and nonspitzoid melanoma.

The use of dermoscopy, along with the conventional, modified clinical ABCD criteria improves detection of melanoma in pediatric patients, according to the results of a recent retrospective study published in the Journal of the American Academy of Dermatology.

With data on the morphologic spectrum of pediatric melanoma scarce, delays in detection and the consequential development of thicker tumors occur. The current study sought to examine the clinical-dermoscopic features of pediatric melanomas. A total of 52 melanomas from 51 patients, diagnosed prior to age 20, were analyzed. Of the 52 lesions, 10 (19.2%) were in situ and 42 (80.8%) were invasive melanoma.

Based on histopathologic findings, the pediatric melanomas were classified as spitzoid (15 lesions; 27.7%) or nonspitzoid (37 lesions; 72.3%). Individuals with a spitzoid melanoma were significantly younger than individuals with a nonspitzoid melanoma (12.5 years vs 16.3 years; P =.004). Notably, most nonspitzoid melanomas were reported in the second decade of life. All of the spitzoid melanomas were invasive and were significantly thicker than the nonspitzoid tumors (2.6 mm vs 1.2 mm, respectively; P =.06). Melanomas were associated more often with a nevus in patients with nonspitzoid vs spitzoid melanomas (62.2% vs 26.7%, respectively; P =.02)

The most common anatomic location of the lesions was the lower extremities (16 of 52; 30.8%), followed by the back (14 of 52; 26.9%). The presence of both red color and shiny white structures was significantly associated with the spitzoid subtype (odds ratio 16.5; 95% CI, 1.7-163.3; P =.02). Dermoscopic spitzoid patterns (pink or pigmented) were significantly associated with a spitzoid histopathologic diagnosis (P <.001).  

The investigators concluded that the addition of dermoscopy to traditional modified melanoma ABCD criteria can help to diagnose melanoma in children as early as possible, with the additional utility of being able to differentiate between spitzoid and nonspitzoid melanomas.

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Carrera C, Scope A, Dusza SW, et al. Clinical and dermoscopic characterization of pediatric and childhood melanomas. Multicenter study of 52 cases [published online October 9, 2017]. J Am Acad Dermatol. doi:10.1016/j.jaad.2017.09.065