Historical Perspective: Becker, 1954; McWhorter and Woolner, 1954

 
In a review article published in 1954 and titled, "Pitfalls in the diagnosis and treatment of melanoma," Becker13 stated that he, too, considered "juvenile melanoma" to be benign. This is how he said it:
 
"A type of tumor which I had always considered as a special variety of childhood nevus was presented by Spitz as juvenile melanoma, which differs from the adult variety by the presence of fusiform or oval cells lacking cohesiveness, usually non-pigmented; failure of such cells to work their way to the surface (this feature was not mentioned by Spitz); presence of giant cells, and failure to metastasize."
 
Also in 1954, McWhorter and Woolner analyzed 172 pigmented lesions diagnosed in children 12 years of age or younger at the Mayo Clinic between 1907 and 1949.14 They sought to clarify confusion that resulted from terms like "juvenile melanoma" and "malignant melanoma" in children and this is how they proposed that it be done:
 
"Lesions that heretofore were grouped under the heading of malignant melanoma have been reclassified into a clinically benign group with a rather distinctive histological pattern (juvenile melanomas) and a numerically smaller group of true malignant melanomas with histological appearances comparable to those seen in such lesions in adults . . . It should be realized that the use of the word juvenile has no absolute relationship to age, as these lesions occasionally occur in adults. Because 'melanoma' to some implies malignancy, one might prefer to designate these lesions as 'benign juvenile melanomas.'"
 
McWorter and Woolner told of five children who had what they thought was authentic melanoma; one had a melanoma situated in a large congenital nevus and the other four had small melanomas that arose de novo. Before the time the article was published, four children were dead of metastases of melanoma, namely, an 8-year-old boy with a large congenital nevus present since birth within which melanoma developed; a 9-year-old girl with a small de novo melanoma on her ear; a 10-year-old boy with de novo melanoma on his cheek; and an 11-year-old boy with a de novo melanoma, the primary site of which was not given. The only survivor was a 4-year-old girl with a de novo melanoma on a cheek who was alive 21 years after excision of the primary neoplasm and who was thought to have metastatic disease by virtue only of "enlarged cervical lymph nodes." Those lymph nodes never were examined histopathologically, but radium was implanted in them nonetheless. In short, the 4-year-old girl was not proven to have had a true melanoma.
 
McWhorter and Woolner, in a general way, described the histopathologic findings in the primary neoplasm of the four children who died thus:
 
"The presence of melanin in all those lesions was corroborated by the results of silver and iron stains. An overlying junctional change was seen in three cases in which the primary tumor was available for study. The cells in all cases showed various combinations of the following characteristics: large size, irregularity in shape and size of nucleus, hyperchromatism with coarse chromatin network, large nucleoli, mitotic figures, and disorganization of pattern . . . The five lesions in this series classed as true malignant melanomas present histological pictures comparable to those seen in adult lesions. Death occurred in four of these five cases. By contrast the eleven tumors classified as juvenile melanomas lack the anaplasia of ordinary malignant melanoma . . ."
 
Some photomicrographs of the five putative melanomas were provided by McWhorter and Woolner, but the few fields "shot" were all shown at intermediate or high magnification (Fig. 3). Therefore, it was cytologic features of the neoplasms were depicted mostly; no neoplasm was pictured at scanning magnification, without which the silhouette of the neoplasm cannot be assessed. Because of the presence of metastases and the eventual demise of these children (the exception being the 4-year-old girl alive nearly two decades later, and excluding Case 1 in which the melanoma began in a giant congenital nevus), there can be no doubt that three of these children had malignant melanoma.

View Figure  		Fig. 3  Comment: Because McWhorter and Woolner depicted this melanocytic neoplasm in a child at intermediate and high magnifications only, it is difficult to determine on the basis solely of the findings shown in their figures 39 and 40 whether it is a "juvenile melanoma" or a malignant melanoma.