Pediatric melanoma: a single-institution experience of 150 patients.
OBJECTIVE
Differentiating pigmented skin lesions from malignant melanoma in the pediatric population has been a challenge. Despite guidelines describing clinical features and histopathologic criteria to distinguish these lesions, misdiagnoses still occur. We report our experience over 30 years in a pediatric population with malignant melanoma.


METHODS
We performed a retrospective review of 150 pediatric patients treated for malignant melanoma between 1973 and 2007 at our institution. Outcomes measured included age, Breslow thickness, Clark level of invasion, tumor location, local and distant failure rates, and overall survival.


RESULTS
One hundred fifty pediatric patients were evaluated. The mean age was 15.1 years. The mean Breslow thickness was 2.05 mm and corresponding Clark level of invasion was 3.47. There were 43 known recurrences (29%); 29 distant, 14 nodal, and 7 local. Overall survival was 84% with a mean follow-up of 8.5 years. Sixteen patients (10.7%) were incorrectly diagnosed on initial pathologic examination. Overall survival in the misdiagnosed group was 66%.


CONCLUSIONS
Pigmented skin lesions in the pediatric population represent a diagnostic challenge to pathologists and clinicians. Improvements in diagnostic techniques with rigorous characterization, as well as increased physician awareness, should lead to a reduction in errors of diagnosis.
Aldrink
Jennifer H
JH
Department of Surgery, Duke University Medical Center, Durham, NC, USA. jennifer.aldrink@nationwidechildrens.org
Selim
M Angelica
MA
Diesen
Diana L
DL
Johnson
Jeffrey
J
Pruitt
Scott K
SK
Tyler
Douglas S
DS
Seigler
Hilliard F
HF
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult