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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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Year : 2013  |  Volume : 18  |  Issue : 4  |  Page : 165-166

Report of a malignant melanoma arising in a small congenital nevus in a 3-year-old child

Pediatric Surgery Department, Salesi Children's Hospital, Ancona, Italy

Date of Web Publication8-Nov-2013

Correspondence Address:
Andrea Zangari
Division of Pediatric Surgery, Salesi Children's Hospital, 11, via Corridoni I-60123, Ancona
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-9261.121122

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How to cite this article:
Zangari A, Ilari M, Nino F, Ascanio M. Report of a malignant melanoma arising in a small congenital nevus in a 3-year-old child. J Indian Assoc Pediatr Surg 2013;18:165-6

How to cite this URL:
Zangari A, Ilari M, Nino F, Ascanio M. Report of a malignant melanoma arising in a small congenital nevus in a 3-year-old child. J Indian Assoc Pediatr Surg [serial online] 2013 [cited 2023 Jan 28];18:165-6. Available from: https://www.jiaps.com/text.asp?2013/18/4/165/121122


Malignant Melanoma (MM) is a rare pathology in childhood. The increased risk of developing melanoma in large congenital nevi is widely accepted, while risk of developing melanoma in small congenital nevi (SCN) is still a matter of controversy. [1],[2] We report a case of melanoma arising in a SCN on right foot in a 3-year-old boy. The lesion was showing enlargement in last 6 months, from 3-4 mm in diameter to 1 cm [Figure 1]. After evaluation by the dermatologist (clinical and with epiluminescence microscopy) the lesion was excised and a broad resection with wide margin. Histopathology showed a melanocytic epithelioid and fusocellular proliferation with mitosis, ulceration and necrosis, leading to diagnosis of nodular MM of Clark level V and 7 mm thickness. Sentinel lymph node biopsy was positive and regional dissection showed micrometastases of a femoral node. No adjuvant treatment was used. [3] Follow-up at 3, 6, 12, and 36 months by blood tests and thoracic X-ray were negative.
Figure 1: Preoperative aspect of the lesion, showing a melanocytic nodule with signs of ulceration

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The increased risk of developing a melanoma in giant and intermediate nevi is frequently reported. SCN are defined as having a diameter less than 1.5 cm. [4],[5] Although rare, the occurrence of MM in small congenital nevi has been described either in adults or in children. [5],[6] We could not find any report of MM arising from SCN in a child younger than 3 years of age. Some authors reported a high percentage of SCN to be associated with melanomas, thus concluding that these lesions may be considered as melanoma precursors. [5] Whether a small melanocytic lesion in a young infant is congenital or acquired soon after birth (tardive nevus) is sometimes difficult to ascertain. [1] Nonetheless, such lesions should be distinguished from melanoma, which may occur in early infancy and even congenitally. Due to the rarity of malignant melanoma in early ages, such a diagnosis may be delayed, leading to worse prognosis. In our case because of late surgical referral, 8 months after the first clinical signs of growth, lead to diagnosis at an advanced stage. Strict monitoring of these lesions by clinical and epiluminescence-based criteria is highly recommended. [5] Furthermore, the diagnosis of true SCN is sometimes difficult and the amount of associated risk is unclear, thus requiring further investigation on the nature and behavior of these lesions.

Our experience confirms that child melanoma can occur in SCN even in early age. Therefore, careful evaluation and monitoring of such lesions is essential, in order to perform prompt excision as clinical change appears.

   References Top

1.Tannous ZS, Mihm MC Jr, Sober AJ, Duncan LM. Congenital melanocytic nevi: Clinical and histopathologic features, risk of melanoma, and clinical management. J Am Acad Dermatol 2005;52:197-203.  Back to cited text no. 1
2.Rhodes AR, Sober AJ, Day CL, Melski JW, Harrist TJ, Mihm MC Jr, et al. The malignant potential of small congenital nevocellular nevi. An estimate of association based on a histologic study of 234 primary cutaneous melanomas. J Am Acad Dermatol 1982;6:230-41.  Back to cited text no. 2
3.Dummer R, Hauschild A, Guggenheim M, Jost L, Pentheroudakis G. ESMO Guidelines Working Group. Melanoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010;21:v194-7.  Back to cited text no. 3
4.Quaba AA, Wallace AF. The incidence of malignant melanoma (0 to 15 years of age) arising in "large" congenital nevocellular nevi. Plast Reconstr Surg 1986;78:174-81.  Back to cited text no. 4
5.Betti R, Inselvini E, Vergani R, Crosti C. Small congenital nevi associated with melanoma: Case reports and considerations. J Dermatol 2000;27:583-90.  Back to cited text no. 5
6.Amagai N, Williams CM. Malignant melanoma arising from a small congenital nevus in a black child. Arch Dermatol 1993;129:1215-7.  Back to cited text no. 6


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