title: Pediatric melanomas often mimic benign skin lesions: A retrospective study.
abstract: BACKGROUND
  Childhood melanoma can be misdiagnosed because of its rarity and atypical presentation.
  
  
  OBJECTIVE
  We sought to correlate the clinical appearance of pediatric melanomas with Breslow depth and clinical behavior, and to identify diagnostic errors made by dermatologists and nondermatologist physicians.
  
  
  METHODS
  This was a retrospective review of Mayo Clinic records of children and young adults 21 years of age or younger with a diagnosis of primary cutaneous melanoma between January 2000 and January 2015.
  
  
  RESULTS
  Pediatric melanomas that mimicked benign skin lesions were more often deeper (>1 mm; odds ratio 5.48; P = .002) and had a higher T stage (odds ratio [T2, T3, or T4] 6.28; P = .001) than melanomas with a clinically malignant appearance. Of pediatric melanomas, 66% originally diagnosed as benign melanocytic lesions exhibited changes in size, shape, and color.
  
  
  CONCLUSIONS
  Sample size and retrospective design are limitations.
  
  
  CONCLUSIONS
  Benign-appearing pediatric skin lesions with a history of evolution, bleeding, or ulceration should raise suspicion for melanoma. 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.
authors.affiliation: Mayo Clinic Department of Dermatology, Jacksonville, Florida. Electronic address: mitkov.mario@mayo.edu.
authors.forename: Mario
authors.initials: M
authors.lastname: Mitkov
authors.affiliation: Mayo Clinic Department of Cancer Biology, Jacksonville, Florida.
authors.forename: Marie
authors.initials: M
authors.lastname: Chrest
authors.affiliation: Division of Biomedical Statistics and Informatics, Jacksonville, Florida.
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Diehl
authors.affiliation: Division of Biomedical Statistics and Informatics, Jacksonville, Florida.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Heckman
authors.affiliation: Mayo Clinic Department of Dermatology, Rochester, Minnesota.
authors.forename: Megha
authors.initials: M
authors.lastname: Tollefson
authors.affiliation: Mayo Clinic Department of Dermatology, Jacksonville, Florida.
authors.forename: Anokhi
authors.initials: A
authors.lastname: Jambusaria-Pahlajani
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001707:Biopsy, Needle; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D015999:Multivariate Analysis; D016017:Odds Ratio; D010372:Pediatrics; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D012871:Skin Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D055815:Young Adult; D000096142:Cutaneous Malignant Melanoma
keywords: Breslow depth; childhood; clinical appearance; early detection; melanoma; pediatric