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Dermatopathology: Practical & Conceptual January - March 2002 >

New Concept: Melanomas in Prepubescent Children: Review Comprehensively, Critique Historically, Criteria Diagnostically, and Course Biologically

Joan M. Mones, D.O.
A. Bernard Ackerman, M.D.

Definition of “Prepubescent” and of Proven “Melanomas” for Purposes of This Treatise

Historical Perspective: Darier and A. Civatte, 1910

Historical Perspective: Coe, 1925; Pack and Anglem, 1939

Historical Perspective: Pack et al., 1947; L. Ackerman and del Regato, 1947

Historical Perspective: Pack, 1948; MacDonald, 1948

Historical Perspective: Spitz, 1948

Historical Perspective: Allen, 1949

Historical Perspective: Spitz, 1951; Pack and Scharnagel, 1951

Historical Perspective: Truax and Allen, 1953; Allen and Spitz, 1953

Historical Perspective: Becker, 1954; McWhorter and Woolner, 1954

Historical Perspective: McWhorter et al., 1954; Hendrix, 1954; Dobson, 1955

Historical Perspective: Allen, 1960

Historical Perspective: Hoagland and Hughes, 1960

Historical Perspective: Pontius and Dziabis, 1961; McGovern and Goulston, 1963

Historical Perspective: Giersten, 1964; Kopf and Andrade, 1966

Historical Perspective: Responses of Allen to Kopf and Andrade, 1966

Historical Perspective: Skov-Jensen et al., 1966; Zwaveling et al., 1966; Saksela and Rintala, 1968

Historical Perspective: Lerman et al., 1970

Historical Perspective: Trozak et al., 1975; Shanon et al., 1976

Historical Perspective: Helwig, 1975

Historical Perspective: Speculations of Helwig, 1975

Historical Perspective: Boddie, et al., 1978

Historical Perspective: Stomberg, 1979; Pratt et al., 1981

Historical Perspective: Flemming and Ruggins, 1985; Bader et al., 1985

Historical Perspective: Peters and Goellner, 1986

Historical Perspective: Moss and Briggs, 1986; Melnick et al., 1986; Chapman et al., 1987

Historical Perspective: Donner et al., 1988

Historical Perspective: Fisher et al., 1988

Historical Perspective: K. Smith et al., 1989: “Malignant Spitz’s Nevus”

Historical Perspective: Partoff et al., 1989; Roth et al., 1990

Historical Perspective: Allen, 1991

Historical Perspective: Temple et al., 1991

Historical Perspective: Crotty et al., 1992

Historical Perspective: A. H. Mehregan and D. A. Mehregan, 1993

Historical Perspective: Tate et al., 1993

Historical Perspective: Chun et al., 1993; Bartoli et al., 1994; Nitta et al., 1995

Historical Perspective: Barnhill et al., 1995

Historical Perspective: Barnhill et al., 1995: “Metastasizing Spitz’s Tumor”

Historical Perspective: Barnhill et al., 1995: “Atypical Spitz Tumor”

Historical Perspective: Lartigau et al., 1995

Historical Perspective: Whiteman et al., 1995; Handfield-Jones and N. Smith, 1996

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

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

Historical Perspective: Wu and Lambert, 1997; Milton et al., 1997

Historical Perspective: Spatz and Avril, 1998

Historical Perspective: Barnhill, 1998; Spatz and Barnhill, 1999

Historical Perspective: Barnhill et al., 1999

Historical Perspective: Rapini, 1999

Historical Perspective: Strojan and Lamovec, 2000; Davis, 2000; Neville et al., 2000

Historical Perspective: Kogut et al., 2000; Patterson et al., 2000; Zuckerman et al., 2001

Historical Perspective: Conti et al., 2001; Fabrizi and Massi, 2001

Summary: Major Sources of Error in Interpretation

Summary: Major Errors of Pack, Spitz, and Allen

Summary: Major errors of Helwig, K. Smith, and Barnhill

Clinical Appearance

Histopathologic Findings (Figure 18)

Histopathologic Findings (Figure 19)

Histopathologic Findings (Figure 20)

Histopathologic Findings (Figure 21)

Histopathologic Findings (Figure 22)

Histopathologic Findings (Figure 23)

Histopathologic Findings (Figure 24)

Histopathologic Findings (Figure 25)

Differences Histopathologically Between Melanomas in Prepubescents and in Postpubescents: Scanning Magnification

Differences Histopathologically Between Melanomas in Prepubescents and Postpubescents: Higher Magnification

Histopathologic Differential Diagnosis

Biologic Behavior

Purpose of This Endeavor and the Essence of the Message

Addendum and Caveat

Acknowledgements

SEE ALSO
- melanoma

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Histopathologic Findings (Figure 21)

Fig. 21 Melanoma in a 3-year-old (our Case 5)At scanning magnification, this neoplasm could be misdiagnosed as a Spitz"s nevus because of its vertical orientation, relative symmetry, and somewhat wedge shape. At intermediate and higher magnifications, findings in the epidermis, at the dermo-epidermal junction, and in the upper part of the dermis also could be misinterpreted as those of Spitz"s nevus, namely, hyperkeratosis, focal hypergranulosis, adnexal hyperplasia, clefts between some fascicles of melanocytes oriented vertical to the skin surface and adjacent keratocytes, and perivascular infiltrates of lymphocytes. The findings at scanning magnification that make this a melanoma are extensive involvement of the subcutaneous fat, confluence of neoplastic melanocytes throughout most of the reticular dermis and in the subcutaneous fat, failure of maturation of melanocytes with progressive descent, melanocytes in the base having large, pleomorphic nuclei punctuated by large nucleoli, and a dense nodular infiltrate of lymphocytes at the base, rather than around blood vessels throughout the neoplasm. The diagnosis of the original histopathologist was Spitz's nevus.

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