Abstract

Melanocytic nevi in children can be acquired or congenital. The vast majority are benign but diagnosis can be difficult. Nevi in newborns and nodular proliferations in giant congenital nevi can display histological features that lend to their misdiagnosis as melanoma. Acquired melanocytic nevi in children are often Spitz nevi or related nevi. These lesions are too often misdiagnosed as melanoma. On the other hand, clinicians and pathologists must be aware that melanoma does occur in childhood, albeit very rarely. It is exceptionally rare in prepubescent individuals. It can be associated with the following risk factors: giant congenital nevus, family history of melanoma, xeroderma pigmentosum, and immunosuppression. Melanoma in children younger than 10 years of age is extremely rare and has different clinical and histopathological features than those that arise in postpubescents, often being confused with a Spitz's nevus. Consequently, the diagnosis is often made too late. It should be emphasized that thickness is the main prognostic parameter in childhood melanoma and that early diagnosis is also crucial in this age group. The lesion must therefore be examined in a complete excision and not in a partial biopsy, and if atypical features are present it must be reviewed by an expert. On the other hand extreme caution should be exercised when diagnosing melanoma in children, as some benign lesions exhibit similar histologic features.