Historical Perspective: Pontius and Dziabis, 1961; McGovern and Goulston, 1963

 
In 1961, Pontius and Dziabis20 commented on a 5 -year-old boy whose skin lesion situated on the left posterior axillary fold was excised but not submitted for examination histopathologically. Four months later, a "mass" in the resultant scar was diagnosed as a "benign pigmented mole." The patient subsequently developed pulmonary and lymph node metastases and died. After reflecting on the findings in their patient and reviewing the literature, the authors arrived at these conclusions:
 
"The malignant melanomas in children show histological patterns of excessive virulence of cellular anaplasia with nuclear pleomorphism, hyperchromatism, variable clumping of nuclear chromatin and increased thickness of nuclear membranes, variability of amount of cytoplasm and increased numbers of mitotic figures. These, combined with a lack of the above described characteristic features of the juvenile melanoma, designate a malignant lesion. The malignant melanomas in children and adults are almost histologically inseparable."
 
In 1963, McGovern and Goulston engaged the subject of "Malignant moles in childhood"21 and reported on eight children whom they judged to be "pre-pubertal," though three were 11 years of age or older, one being 11 and two 12. Four of the eight children, including two of the three children who were 11 years of age or older, had died of metastases before the article was completed. McGovern and Goulston began their essay with this sentence:
 
"Malignant melanoma rarely affects children, but when it does, it behaves in exactly the same way as it does in adults."
 
That statement is only partially true. It is true that melanoma affects children rarely and when it does has capability to metastasize and cause death. As will become apparent as the reader reads on, however, melanomas in prepubescents behave differently in some respects from melanomas in postpubescents.
 
With respect to the development of melanoma in association with a congenital or an acquired nevus, McGovern and Goulston made these statements:
 
"Most naevoid [congenital] moles which become malignant do so before the patient reaches the age of 50 years, while most acquired lesions [moles] which become malignant do so after that age. . . . In seven of our eight cases the moles which became malignant were of the naevoid type."
 
The meaning of those sentences is elusive to us.
 
Based on all of their findings, McGovern and Goulston arrived at these conclusions:
 
"Our observations lead us to believe that moles of congenital or nevoid type may become malignant independent of solar exposure and that most of those occurring in childhood fall into this category. Acquired naevi which become malignant are mainly the result of excessive solar exposure in fair-skinned persons. One example of this type was seen in a child who suffered from xeroderma pigmentosum. The behavior of melanoblastoma in children is similar to its behavior in adults and so it should be treated similarly."
 
McGovern and Goulston were under the misapprehension that most melanomas in children developed in a pre-existing nevus, whereas, in reality, the majority of those melanomas arise de novo, that is, not in association with either a congenital or an acquired nevus.