title: Lethal melanoma in children: a clinicopathological study of 12 cases.
abstract: Melanoma in children is rare, representing 3% of paediatric malignancies and <1% of all melanomas. Very few detailed descriptions of bona fide lethal childhood melanomas exist in the literature. We performed a retrospective clinicopathological review of 12 paediatric (≤16 years) melanoma patients who died of metastatic disease, including detailed assessment of architectural and cytomorphological features. There were nine prepubertal patients (median age 7 years old) and three postpubertal cases (median age 15 years old). The patients died on average 45.7 months after diagnosis with the prepubertal subcohort showing a relatively longer time from diagnosis to death. The tumours were bulky (average tumour thickness=10mm), showed brisk mitotic activity (average mitotic count per mm2=7), and were formed by large expansile nodules with sheet-like growth pattern and infiltrative borders in the majority of cases (83%). Cytologically, large grossly pleomorphic epithelioid cells with massive eosinophilic macronucleoli were present in most cases (75%). In this cohort, we did not identify specific features of melanoma that were unique to children. Although melanomas are extremely rarely encountered in childhood, the above-cited unequivocal malignant features should prompt an outright diagnosis of melanoma even in a paediatric patient.
authors.affiliation: Department of Pathology and Dermatology, Moffitt Cancer Center/University of South Florida, Tampa, FL, United States. Electronic address: Carlos.prietogranada@gmail.com.
authors.forename: Carlos N
authors.initials: CN
authors.lastname: Prieto-Granada
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Lezcano
authors.affiliation: Melanoma Institute Australia, North Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Scolyer
authors.affiliation: Dermatology Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Mihm
authors.affiliation: Dermatology Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Adriano
authors.initials: A
authors.lastname: Piris
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology*
keywords: Lethal melanoma in children; architectural features; clinicopathologic assessment; cytomorphologic features; paediatric melanoma