Historical Perspective: Temple et al., 1991

 
In 1991, Temple et al.47 presented the results of a population-based study of patients 20 years of age or younger who had been diagnosed as having either a Spitz's nevus or a melanoma and who had been listed in the Provincial Cancer Registry of Calgary, Alberta, Canada during the period of 1955 to 1985. They identified 21 patients, ranging in age from 9 to 19 years (mean age 16.4 years), with what they considered to be a melanoma for these reasons:
 
"The criteria for the diagnosis of melanoma in children are the same as in the adult. The most common features of malignant melanoma are: (1) single-cell intraepidermal spread of melanocytes throughout all levels of the epidermis; (2) asymmetry; (3) poor lateral circumscription; (4) mitotic activity; (5) cytologic atypia; (6) lack of maturation of melanocytes toward the base of the lesion; and (7) inflammatory dermal reaction. Other features used less frequently, but highly supportive of a diagnosis, include lymphatic or blood vessel invasion and ulceration of epidermis due to invasion. Nuclear atypia is less dependable because it is dependant on the vagaries of processing and cutting and is open to reviewer bias."
 
This analysis prompted Temple and coworkers to come to these conclusions:
 
"There was a suggestion that patients with deeper lesions had a worse prognosis, but this was statistically confirmed using only Clark's levels. The children were then compared with all melanoma patients diagnosed in southern Alberta over the same time period. There was no difference in tumor depth, Clark's level, ulceration, regional involvement, or survival between these two groups. The natural history in children appears to be similar to that of the adult population, contrary to previous reports suggesting a markedly worse prognosis."