Historical Perspective: Scalzo et al., 1997; Eady, 1997; Crotty, 1997; Zhu et al., 1997

 
Scalzo and collaborators, in 1997,63 recounted their experience with melanomas in 22 children 15 years of age and younger who had been treated at the Pigmented Lesion Clinic of the Massachusetts General Hospital over a 33-year period between 1962 and 1995. Only three of the 22 patients were 10 years of age or less, to wit, 10, 9, and 6 years of age (their Cases 5, 6 and 12, respectively) and all of them were alive after follow-up of 77, 18, and 60 months, respectively. No photomicrographs were accompanying. Scalzo et al. had this to say regarding the distinction histopathologically of Spitz's nevus from melanoma:
 
"The principal difficulty in the differential diagnosis of melanocytic tumours of childhood is the differentiation of the compound naevus of Spitz from malignant melanoma. There is no single criterion which is reliable in distinguishing the two lesions in young patients. . . . Histological features of malignant melanoma vary from lesion to lesion, and reliable diagnosis depends on recognition of a constellation of features."
 
Unfortunately, Scalzo and colleagues provided no information about what findings do enable a histopathologist to render a diagnosis, with repeatability and reliability, of Spitz's nevus and of melanoma.
 
In a letter to the editor of the British Journal of Dermatology in 1997 concerning "Malignant melanoma in childhood," Eady64 wrote of his experience with two children, a 14-year-old boy and a 12-year-old boy, the former with a "superficial spreading melanoma" 1.1 mm thick on his back that had metastasized to cervical lymph nodes, but who was well four years after diagnosis of primary melanoma had been made, and the latter with a "nodular melanoma" 4.6 mm in thickness on the scalp from which metastases had gone to regional lymph nodes, but who also was said to be free of disease one year later. Eady made no mention of histopathologic findings in either melanoma.
 
In 1997, K. A. Crotty wrote again about "Spitz's nevus: Histological features and distinction from malignant melanoma."65 With regard to "Spitz's nevi" that metastasized, she made these comments correctly:
 
"It is suggested that some cases of Spitz's naevus may metastasize to local lymph nodes and no further. Further study of these cases is warranted. If a lesion has been previously diagnosed as Spitz's naevus and subsequently metastasizes, especially beyond local lymph nodes, the lesion should not be called a metastasizing Spitz's naevus, or a malignant Spitz's naevus, but rather it should be reclassified as a Spitz-like malignant melanoma."
 
The last sentence of Crotty would have been better had the word "especially" been omitted.
 
In 1997, Zhu and coworkers66 in the Departments of Plastic Surgery and Histopathology at the Franchay Hospital in Bristol, England reported on melanoma in 47 patients 21 years of age or younger, including 10 children 14 years of age or less, a period of time which the authors considered to be "preadolescent." Twenty-nine of the patients in this series were those reported on in 1986 by Moss and Briggs. No photomicrographs were shown, but this is what the authors wrote about problems in distinguishing melanoma from Spitz's nevi histopathologically:
 
"The differentiation of Spitz's naevi from invasive melanoma remains a problem. It has been said that the only certain method of diagnosing malignancy is when metastatic spread occurs. Of note, in our series, one case, an 8-year-old boy with a lesion on the scalp, was initially diagnosed as having a Spitz's naevus but later (5 years) developed nodular metastatic disease. He subsequently died from melanoma (7 years, 4 months after diagnosis). In the literature, there are many reports of lesions initially diagnosed as Spitz's naevi in which subsequent metastatic disease occurred. Such misinterpretation undoubtedly occurs as a result of genuine difficulty in differentiation but it may be compounded by a reluctance on the part of the pathologist to make the diagnosis of malignant melanoma in a child. In our report we can only re-emphasize that whilst the condition is rare it certainly exists."