Change in a child's naevus prompts referral to a dermatology service (original) (raw)

Diagnosis and management of melanocytic skin lesion in the pediatric praxis A review of the Literature

Children may present a variable spectrum of melanocytic skin lesions and the great majority of them is benign. Childhood melanoma is still exceptionally rare, although recent data suggest an increasing incidence even in young age. The optimal management of children presenting with melanocytic skin lesions aims therefore to a twofold goal, that is to reduce unnecessary surgical excisions of benign melanocytic nevi without running the risk to miss melanoma. Dermoscopy is an in vivo, noninvasive optical tool that aids to approaching this goal. It comes therefore not as a surprise that dermoscopy has gained popularity for the diagnosis and management of pigmented and nonpigmented skin lesions in the pediatric praxis. In this article, we provide a review of the current literature on dermoscopy patterns of melanocytic skin lesions and their management with special emphasis to a pediatric population. Moreover, we discuss recent concepts regarding nevogenesis and highlight some controversial aspects regarding childhood melanoma.

Melanocytic skin lesions in children: dermoscopy patterns and management considerations

Children may present a large spectrum of melanocytic skin lesions, of those the great majority are benign nevi, while childhood melanoma is exceptionally rare. However, due to this and other reasons, the diagnosis of childhood melanoma is often delayed. The optimal management of children presenting with melanocytic skin lesions aims therefore at a two-fold goal: first, to reduce surgical excisions of benign melanocytic nevi, and second, to improve the early diagnosis of melanoma. Dermoscopy has been shown to reach this goal, which explains the increasing use of this noninvasive technique for the daily management of patients with pigmented and nonpigmented skin lesions. Supplementary digital dermoscopic follow-up allows the observation of dynamic changes over time, which improves not only the early diagnosis of melanoma, but allows new insights into the natural evolution of melanocytic nevi. In this article, we reviewed the current literature on the dermoscopy patterns of melanocytic skin lesions in childhood and considerations on their management as well as on new concepts of nevogenesis and ongoing controversies regarding childhood melanoma.

Instrument-, age- and site-dependent variations of dermoscopic patterns of congenital melanocytic naevi: a multicentre study

British Journal of Dermatology, 2006

Background Recently, we identified and described dermoscopic aspects, present with a higher frequency in congenital melanocytic lesions with respect to acquired naevi. We also classified small-and medium-sized congenital naevi (CN) into nine subtypes according to their macroscopic and dermoscopic aspects. Objectives Because the recognition of dermoscopic features may be instrument dependent, in this study, we wanted to check whether dermoscopic patterns specific for CN can be identified in digital images acquired by means of different instruments. We also wanted to check the validity of our previously proposed classification and assess possible age-and site-dependent variations of dermoscopic patterns and naevus subtypes. Patients/methods Images corresponding to 384 small-or medium-sized CN were collected in eight different centres employing four different instruments. Lesion images were evaluated and checked for the presence of specific dermoscopic criteria, classified, and compared with a database of 350 acquired naevi. Results Specific and unspecific dermoscopic features were identifiable in images acquired by means of all four instrument types. The mean number of identified features per lesion did not vary according to the instrument employed for the acquisition of the images; however, it was lower for lesions recorded employing low magnifications. The previously proposed classification was easily applied to the whole image database. The variegated naevus type was identified as a highly specific clinical/dermoscopic pattern. Dermoscopic features varied according to age and location. The globular type prevailed in subjects under 11 years of age and on the trunk, whereas the majority of reticular lesions were located on the limbs. Conclusions Because definite clinical and histological criteria for the diagnosis of the congenital nature of naevi are lacking, the use of dermoscopy can be of great help in identifying those lesions where the presence of specific dermoscopic features makes the diagnosis of CN more likely. Moreover, dermoscopy can be useful both for the classification of lesions already identified as congenital according to definite clinical and anamnestic data and for a possible correlation of naevus phenotype and dermoscopic patterns to the risk of developing a malignant melanoma in prospective studies.

Dermoscopic Changes in Melanocytic Naevi in Children during Digital Follow-up

Acta Dermato Venereologica, 2012

The aim of this study was to investigate the dermoscopic changes in acquired melanocytic naevi in a large paediatric population over an interval of several years. Images of 717 melanocytic naevi were obtained from 160 consecutive patients. Dermoscopic pigment pattern changes were observed in one of two lesions after a follow-up of one year, in 34 of 295 lesions (11.5%) after 2 years, in 40 of 190 lesions (21.1%) after 3 years, in 40 of 141 lesions (28.4%) after 4 years, in 5 of 37 lesions (13.5%) after 5 years, in 12 of 31 lesions (38.8%) after 6 years, and in 7 of 21 lesions (33.3%) after 7 years. Dermoscopic changes were detected in 25.3% of the lesions in patients aged 3-6 years, in 21% of the lesions in patients aged 7-12 years, and in 15.5% of the lesions in patients over 13 years. Main pattern changes consisted of transition from globular to globular-reticular (35 naevi), from globular to reticular (14 naevi) and from globular-reticular to reticular (24 naevi). These results are consistent with the view that melanocytic naevi generally undergo a characteristic transition from a globular pattern to a reticular pattern. Most of the changes are observed in the 3-6 years age group when hormonal and/or environmental factors are not thought to play a role in pattern alterations.

Analysis of clinical and dermoscopic features in melanocytic lesions with special emphasis on problematic lesions in children

Expert Review of Dermatology, 2013

Most melanocytic lesions in children are considered 'nonproblematic' and are managed conservatively because of their invariable benignity. Congenital melanocytic nevi (CMN) and Spitz nevi are the most problematic pigmented lesions in childhood. Regarding CMN, the biggest risk of melanoma development occurs with increased nevus size, being particularly high in giant CMN, in children younger than 10 years. On the other hand, awareness should be related to new, rapidly growing lesions (the clinical hallmark of Spitz/Reed nevi and melanoma). The aim of this review is to present clinical and dermoscopic features of a large spectrum of pediatric melanocytic lesions with special attention to problematic lesions that may occur in childhood.

Management of Congenital Melanocytic Naevi in Children: A French National Survey Using Clinical Vignettes

Acta Dermato Venereologica

Despite the frequency of congenital melanocytic naevi, their therapeutic management does not usually involve shared decision-making, and may vary depending on the habits and experience of each clinician. This survey reveals the variability of management of congenital melanocytic naevi among clinicians at a national level in France. Manage ment varied depending on: the clinician's level of experience in oncodermatology; their previous management of a melanoma on congenital melanocytic naevi; their seniority; and the case-load mix. National recommendations to standardize clinical practice and the information provided to patients should be developed to help guide a shared decision-making process. Management of congenital melanocytic naevi in childhood may vary depending on the habits and experience of the treating clinician. The aim of this study was to assess current practice and determinants of surgical excision decision-making among French physicians. A national survey was conducted among dermatologists, paediatricians and surgeons, using clinical vignettes illustrating 29 scenarios. The primary outcome was the decision to perform surgical excision in each vignette. Of the 11,310 decisions made by the 390 participants (257 dermatologists, 35 surgeons, and 98 paediatricians) surgical excision was chosen in 33% of cases. The stated motivations for performing surgical excision were: melanoma risk, aesthetic/psychosocial risk, or both, in 39%, 34% and 27% of cases, respectively. Physicians with a higher level of experience in oncodermatology were more likely to opt for surgical excision. The age of the child, the size of the congenital melanocytic naevi, and the visibility of the lesion had no influence on the decision to perform surgical excision.

Excised melanocytic lesions in children and adolescents – a 10-year survey

Background Early recognition and prompt excision is to date the only available strategy for reducing mortality from melanoma. Little is known about the accuracy of melanoma detection in children and adolescents. Objectives To assess the accuracy of melanoma detection in a paediatric population. Methods From the Department of Dermatology, Medical University of Graz, Austria, we reviewed the dermatopathology reports of naevi and melanomas excised in patients younger than 20 years over a 10-year period (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007). Patients were subdivided into four age groups: 0-4, 5-9, 10-14 and 15-19 years. Results Accuracy in melanoma detection was tested using the number needed to excise (NNE) value that is obtained by dividing the total number of excised lesions by the number of melanomas. A total of 22 564 lesions were reviewed, disclosing 22 526 naevi and 38 melanomas, for an overall NNE value of 593AE8. Five melanomas were excised in children aged 10-14 years (NNE 1141) and 33 in children aged 15-19 years (NNE 479AE8), whereas no melanomas were found among 1026 lesions excised in children younger than 10 years. In children aged 0-4 years, congenital and Spitz ⁄Reed naevi accounted for 34AE5% and 20% of lesions, respectively. These percentages decreased progressively when moving to older age groups (P < 0AE0001). In contrast, the percentage of dermal and compound naevi rose in direct proportion with age, being 3AE4% and 20AE7%, respectively, in the youngest age group, and 36AE7% and 31AE9%, respectively, among the oldest patients (P < 0AE0001). Conclusions The overall NNE value in paediatric patients over the 10-year study period was 593AE8, meaning that about 594 lesions were excised to find one melanoma. This value is 20 times higher than the rates found in adult patients.