INTRODUCTION
Melanoma is a rare yet deadly disease in the pediatric population, and often has distinct clinical attributes compared with adult melanoma. Data from the Surveillance, Epidemiology, and End Results (SEER) program shows an overall steady increase in pediatric melanoma by approximately 2% per year.1,2,3 Childhood melanoma is more common in boys and most often presents in the face and trunk, whereas adolescent girls are at increased risk for a more distal manifestation, specifically in the lower extremities and hips.4 Melanoma has a multifactorial causality and is associated with genetic and environmental factors, including sun exposure, Fitzpatrick pigmentation phenotype, large congenital nevi, familial melanoma and autoimmune diseases.5,6,7
The risk of malignant degeneration in small and medium congenital nevi is exceedingly minimal and does not warrant any clinical intervention. In contrast the risk of melanoma in large or giant congenital nevi is estimated to be 2-5% over lifetime, with a significant risk during the first decade of life.8 The total number of acquired melanocytic nevi on the body is an important risk factor for melanoma. The risk of melanoma is directly proportional to the increase in number of nevi.9 Dysplastic nevi are distinguished on the basis of histological features and are considered to be a marker for an increased risk for the development of melanoma.10,11 Finally, Spitz nevi are a variant of acquired melanocytic nevi, presenting as a small pink to red papules on the face, considered benign, yet a minority may exhibit clinical and histological atypia, featuring risk for melanoma.12
The frontline of melanocytic nevi management relies on patient and caregiver education. It includes both preventative measures and instructions for routine skin evaluation.13,14 However, it is important to note that in the pediatric population clinical characteristics do not always follow the typical “ABCDE†detection criteria. Pediatric melanoma characteristics are amelanosis, bleeding, color uniformity, diameter variability, and de novo development. Certain studies estimate that the ABCD screening system fails to recognize 60% of childhood and 40% of adolescent melanomas.15,16,17
The gold standard for melanoma detection has always been to perform a biopsy and assess the sample histopathologically.18, 19 However, non-invasive techniques can help clinicians avoid biopsies especially when attempting a diagnosis in the pediatric population.2,20 There are many emerging technologies that intend to serve as diagnostic aides in order avoid unnecessary biopsies instead of relying on clinicians' interpretation of potential for malignancy.
