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Pediatric melanomas mimic benign skin lesions

Pediatric melanomas that mimicked benign lesions had certain risk factors, including a history of evolution, bleeding and ulceration, according to recently published study results.

Researchers conducted a retrospective review of records at Mayo Clinic, Rochester, Minnesota, between Jan. 1, 2000 to Jan. 1, 2015, of patients aged 21 years and younger with a diagnosis of primary cutaneous melanoma. There were 86 patients (60.5% female; median age at diagnosis, 17 years) with 96 distinct primary melanomas included in the study.

They found that pediatric melanomas that resembled benign lesions often had a Breslow depth of more than 1 mm (OR = 5.48; 95% CI, 1.66-20.12) and also had a higher T stage (OR = 6.28; 95% CI, 1.87-21.14), compared with melanomas with a malignant appearance.

Of 24 pediatric melanomas incorrectly diagnosed as benign nevi, 66% exhibited change in size (n = 12), shape (n = 3) and color (n = 10).

A history of clinical ulceration (P = .016) and bleeding (P = .033) were more likely in melanomas thought to be benign lesions compared with melanomas with malignant appearance.

“Because many pediatric melanomas resemble benign skin lesions, identification of predictive risk factors is important,” the researchers wrote. “Pediatric melanomas often do not present with the traditional ABCDE criteria. Delay in detection may stem from a lack of specific gross morphologic features, as exemplified by our finding that dermatologists were not better than nondermatologists at correctly distinguishing melanomas from benign lesions.”

“Benign-appearing pediatric skin lesions with a history of evolution, bleeding or ulceration should raise suspicion for melanoma,” the researchers concluded. “Melanomas demonstrating these features are associated with a higher Breslow depth and T stage. Although biopsy of all lesions that exhibit change in children is not practical, safe, or desired, close monitoring is recommended.”  – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.