A Case of Pediatric Melanoma: Treatment Considerations in Advanced Disease.

Each year, more than 76,000 new cases of melanoma are diagnosed in the United States.1 Pediatric melanomas account for 0.7% of all cases and 0.1% of subsequent mortalities. The incidence of pediatric melanoma rises 2.6% annually, which may be partially explained by changes in sun-related behavior, yet the use of tanning beds and increases in ultraviolet exposure do not account for rises in prepubertal populations.1–3 As the number of children diagnosed with melanoma continues to rise, accurate and timely diagnosis and treatment becomes even more paramount. Clinical suspicion remains the cornerstone of diagnosis and depends on an appreciation of the unique clinical features of pediatric melanoma. Risk factors for melanoma common to both pediatric and adult populations include Fitzpatrick 1 skin phenotype, positive family history, previous malignancies, concomitant medical conditions such as xeroderma pigmentosum, and chronic immunosuppression.3,4 In contrast to established risk factors for adults, sun exposure does not correlate with prepubertal, pediatric melanoma. Rates of disease are highest in areas of low ultraviolet-B exposure based on geographic location in that patient population.1–3 The incidence of melanoma in adolescents, on the other hand, more closely mirrors the adult melanoma population correlation with increased ultraviolet-B exposure. Traditional detection criteria used in adults often fail to identify malignant lesions in children. Suspicious clinical findings in children include amelanosis, bleeding, raised lesions, color uniformity, and de novo lesion development.3,5 Furthermore, classic prognostic features, including tumor depth of invasion and lymph node involvement, less clearly impact survival in children.6,7 We report on a case of melanoma in a 3-year-old patient to address the clinical features of this disease in the pediatric population and review some of the factors used to guide treatment options.