Historical Perspective: Pack et al., 1947; L. Ackerman and del Regato, 1947

 
In 1947, Pack and his collaborators revisited the subject of melanomas in children in an article headed, "The treatment of malignant melanoma—Report of 862 cases."3 There they recorded their findings in 15 children of "pre-pubertal age" who had what they considered to be authentic melanoma. Once again they defined prepubescent as "under 16 years of age." The "pre-pubertal melanomas" behaved in a benign way, and this is what Pack et al. said about the paradox:
 
"We reviewed 951 cases of malignant melanoma, of which 862 were available for critical analysis and 595 for determination of five-year end-results . . . [Of the 595 cases] there was a series of 15 patients of pre-pubertal age who had tumors histologically classified as malignant melanomas. Although the microscopic appearance of these pigmented tumors is so identical with their congeners of adult life that pathologists cannot distinguish between them, their behavior is not in keeping with their anatomical structure. None of these melanomas metastasized and all of the patients have survived indefinitely. . . . Inasmuch as the behavior of this tumor is so benign and the prognosis is so good, it would be well to classify it separately as pre-pubertal melanoma."
 
Also in 1947, in a chapter titled, "Malignant melanomas of the skin," L. Ackerman and Del Regato4 made these comments about melanomas in children:
 
"The malignant melanomas, which very rarely occur in children, are extraordinary in that with proper treatment they have an excellent prognosis even if regional node metastases are present. These metastases, as a rule, are infrequent."
 
A metastasis of melanoma, no matter how seemingly circumscribed is indicative of widespread metastases and signals a grave prognosis.