In 1978, Boddie and colleagues, in an article concerning "Malignant melanoma in children and young adults: Effect of diagnostic criteria on staging and end results,"³¹ offered and employed criteria for distinguishing melanoma histopathologically from Spitz's nevus. Those criteria were derived from their analysis of findings in melanoma in 125 patients whose records were culled from 3,175 patients diagnosed as having melanoma at M.D. Anderson Hospital between 1944 and 1975. The melanomas in their series had been biopsied some time between birth and 29 years of age. Of the 125 melanomas, 15 were in children 12 years of age or younger. Stereotypical of the histopathologic attributes that Boddie and associates considered requisite for diagnosis of melanoma were those in an 11-year-old boy whose neoplasm on a shoulder had metastasized and caused death two years after the diagnosis of the primary neoplasm had been established. The histopathologic findings in the melanoma in that boy were described by Boddie et al. as follows:

". . . Within the epidermis there was a proliferation of atypical, moderately pleomorphic melanocytic cells. Individual cells and small clusters of cells were observed progressing upward in the epidermis some clusters being extruded onto the surface. Pigmentation of the cells ranged from slight to marked. Mitotic figures were found with ease, there being 20 per ten high power fields, or an average of approximately two per single HPF [high power field]. Several of the mitoses were abnormal. Invasion extended into the reticular dermis, making it a level IV lesion. Its greatest thickness was 1.8 mm. The cells infiltrating the reticular dermis did not show the 'fixed' relationship with the dermal stoma as seen in benign nevi, including spindle and epithelioid cell nevi. The inflammatory response was minimal in this lesion, suggesting poor immunologic defense against the tumor."

Apart from the number of mitotic figures and the abnormality of some of them, the criteria used by Boddie and co-workers for distinguishing spindle and epithelioid cell nevus from melanoma are not effective; the histopathologic changes recorded by them may be observed in both the benign and the malignant neoplasm.

Boddie and collaborators took note of the fact that "All patients under 12 years of age in this series, however, who developed clinical criteria of malignant melanoma such as regional or distant metastasis after excision, ultimately died of their disease." This is in striking contrast to the inference of Helwig who had championed the idea that true melanomas in children, even those that had metastasized, had a better prognosis than melanomas in adults, especially when the melanomas in children bore resemblance histopathologically to spindle and epithelioid cell nevus.

One hundred and ten melanomas in the series of Boddie and collaborators occurred in teenagers between ages 13 and 19. That prompted them to comment about the influence of puberty on melanoma thus: