In 1975, Trozak and associates reviewed the literature concerning metastatic melanoma in pre-pubertal children.²⁸ They classified the melanomas as follows: "Type I" referred to melanoma acquired transplacentally, "Type II" to melanoma that metastasized at the onset before puberty, and "Type III" to melanomas that began before puberty in a giant melanocytic nevus. Although they never defined what they meant by puberty, the authors did include children 14 years of age or younger in their series. With regard to Type II melanomas, that is, their 44 examples of primary melanomas that metastasized before puberty, Trozak et al. made these observations:

Trozak and coworkers also presented one patient of their own, a 4-month-old male infant with a 3.0 mm pigmented lesion on the cheek that was "first noted three weeks earlier by the mother [and subsequently] the lesion had grown rapidly." The child developed metastases to regional lymph nodes 16 months later and was said to be free of disease 20 years later. By "free" the authors could only have meant free of overt signs of metastasis. Trozak et al. showed clinical pictures of the primary neoplasm and of the metastases, as well as photomicrographs taken at high power of the histopathologic findings, about which they commented thus:

In 1976, Shanon and associates, in an article captioned, "Malignant melanoma of the head and neck in children: Review of the literature and report of a case,"²⁹ opined that melanomas of the head and neck are rare in children. That they commented on a 2-1/2-year-old girl who at one year of age was diagnosed as having a melanoma that developed de novo on the helix of her right ear. One and a half years later, metastases were found in a cervical lymph node. Review of the literature enabled Shannon et al. to identify 13 examples of melanoma on the head and neck of children. That they concurred with McGovern and Goulston and with Kopf and Andrade about the behavior of melanomas in children is evident in this sentence of theirs: