Children and adolescents 20 years of age or less with cutaneous melanoma were reported on by Tate and coworkers in an article published in 1993 titled, "Melanoma in childhood and adolescence: Clinical and pathologic features of 48 cases."⁵⁰ The study spanned a 23-year period between January 1968 and August 1991, and was carried out in the Division of Surgical Oncology at the University of Illinois. Fourteen children were considered to be "preadolescent," i.e., 13 years of age and younger, and 34 were "adolescent", i.e., older than 13 but less than 20 years of age. Twenty-one of the 48 melanomas were said to be associated with a nevus, five of those nevi being designated "congenital." At the time of diagnosis, four children were receiving exogenous hormone therapy, namely, a 4-year-old boy on thyroxine for congenital hypothyroidism, a 10-year-old girl on estrogen replacement because of a hysterectomy and bilateral oopherectomy for a congenital malformation, and two 19-year-old girls on oral contraceptives. Tate and coworkers showed only high power photomicrographs and those being of the melanomas in two children, one in a 10-year-old boy with albinism that metastasized to an inguinal lymph node, and the other in a 12-year-old girl whose "nodular" melanoma was diagnosed at first as Spitz's nevus and in whom "massive inguinal metastases" developed 14 years later, resulting in her death the following year. A 4-year-old girl developed a melanoma in association with a giant hairy nevus and that malignant neoplasm metastasized to the brain, causing her to succumb in four months.

The experience with these children led Tate and coworkers to come to these conclusions:

Because two of their patients (patients #4 and #7) had melanomas that were interpreted histopathologically as Spitz's nevi and yet metastasized with fatal consequences, Tate et al. offered these thoughts about the differentiation histopathologically of Spitz's nevus from melanoma:

We concur with Tate and coworkers that melanomas may have histopathologic findings in common with those of Spitz's nevus and that the distinction of melanoma from Spitz's nevus may at times be exceedingly difficult. We do not agree, however, that melanomas "have a higher degree of pagetoid spread of the tumor into the overlying dermis, cellular pleomorphism, nuclear hyperchromatism, and increased mitotic activity." Pagetoid melanocytes themselves are seen often in melanomas and practically never in Spitz's nevi, but pagetoid pattern of melanocytes within the epidermis is of no avail in distinguishing the malignant from the benign neoplasm; scatter of abnormal melanocytes throughout the epidermis often is present in both. In the ultimate analysis, the silhouette of the neoplasm as assessed at scanning magnification of a conventional microscope is the surest route to differentiation of melanoma form Spitz's nevus; cytopathologic attributes of the abnormal melanocytes may be helpful to that end, but not invariably.