Historical Perspective: Spatz et al., 1996; Naasan et al., 1996

 
In 1996, Spatz and associates, in an article captioned, "Melanoma in childhood: An EORTC-MCG study on the clinico-pathological aspects,"60 communicated the results of a multicenter study of 102 cutaneous melanomas in children 16 years of age or younger. The neoplasms were collected from members of the EORTC-Melanoma Cooperative Group between the years 1961 and 1994. Sixty of the 102 cases were thought by Spatz and colleagues to be authentic melanomas and 42 of the 102 were reclassified as Spitz's nevi after findings in sections of tissue had been reviewed. Eighteen of the melanomas were associated with such predisposing conditions as a congenital nevus, a family history of melanoma, and xeroderma pigmentosa. Clinical follow-up ranged from none to 27 years, the mean being five years. Information about each of the patients was entered into a computerized database and statistical analyses were performed. Based on these assessments, Spatz and coworkers came to view certain matters in this way:
 
"Confirmed melanomas were larger (i.e., 7 mm), and more often presented ulceration, high mitotic activity (5 mitoses/10 HPF [high power field]), mitosis in the lower third of the lesion, epithelioid melanocytes, asymmetry, lateral borders not well demarcated, lack of maturation, dusty melanin, and marked nuclear polymorphism . . . In 59 melanomas, the mean thickness was 3.00 mm, with a range of 0.20 mm to 15 mm; 39 cases (66%) were thicker than 1.5 mm."
 
With respect to information gleaned from follow-up, Spatz and associates made these comments:
 
"Among 60 patients with melanoma, follow-up ranged from 0 to 27 years (mean: 5 years). Nine patients had no follow-up. Forty-one patients (68%) were followed for more than one year. Twenty (39%) of the 51 patients with follow-up have had metastasis. Seven of these died of their disease, including one patient (Case 11) who died with multiple metastasis 14 years after the diagnosis, 3 were alive with melanoma, and 10 were free of disease after 44 and 328 months of follow-up (mean: 115 months). Thirty-one patients remained free of disease, with follow-up duration of 5 years or more for 20 patients. The 5-year survival rate is 84% . . . The only statistically significant [histopathologic] parameter associated with the development of metastasis or fatal outcome was a thickness of more than 2.0 mm (p<0.001)".
 
In 1996, Naasan et al.61 told of their findings about cutaneous melanoma in 50 patients 14 years of age or younger whose neoplasm had been reported to the Scottish Melanoma Group which, since 1979, had registered 4700 melanomas. Of these 50 children, 15 were considered to be "prepubertal," defined by them as "14 years old or younger in males but 12 years old or younger in females." Eight patients developed metastases of melanoma. One of them, 10 years old at the time of diagnosis of the primary neoplasm, developed lymph node metastases five months later and died after 2 1/3 years. Based on the assessment of the histopathologic findings in these 50 melanomas, no photomicrographs of which were shown, Naasan and coworkers opined as follows:
 
"Histological review showed that the majority of cases (58 percent) exhibited typical cytological and architectural features of melanoma. In the remaining cases, the lesions were difficult to fit into any of the classic patterns of malignant melanoma or of the known benign nevocellular lesions. . . . Forty years after Spitz's initial description the overlap in the histological features remains considerable. Both melanomas and Spitz nevi have so many histological features in common that errors of overdiagnosis as melanoma, or of underdiagnosis as benign lesions are not infrequent. . . . Melanoma in children and adolescents remains rare. The disease behaves similarly to that in adults; hence, treatment should be the same."