Primary melanoma occurs in prepubescent children, even in those who are younger than 1 year of age.

Melanoma in prepubescent children does not present itself clinically like melanoma in a postpubescent; the "ABCDs" are missing and therefore, a melanoma often is misdiagnosed clinically (as was the case for all 11 melanomas in our series).

By the time a melanoma in a prepubescent child is biopsied, it usually is very thick, an indication that it has grown very rapidly and that is why it presents itself clinically as a papule or nodule.

At scanning magnification, the silhouette of melanoma in a prepubescent child is distinctive and different in many ways from a melanoma as it is seen usually in postpubescents (Table 3).

A melanoma that occurs in a prepubescent child can be confused easily with a Spitz's nevus, particularly in a shaved-off biopsy specimen.

Melanoma in a prepubescent child often is misdiagnosed histopathologically as "atypical Spitz's nevus," "Spitz's nevus," and "cellular blue nevus," not as melanoma (as was the case for 10 of the 11 melanomas in our series, only one of which was "signed out" in a clear-cut manner as "melanoma"

By applying scrupulously criteria for differentiation histopathologically of melanoma in prepubescents from Spitz's nevus (Table 5), distinction between them can be made.

A Spitz's nevus that metastasizes is a melanoma that was misdiagnosed.

A Spitz's nevus diagnosed histopathologically as a melanoma is still a Spitz's nevus.

Diagnosis of Spitz's nevus and of melanoma in a prepubescent child should be made on the basis of morphologic findings only and never on the basis of other considerations, such as age or race.