Atypical Presentation of Malignant Melanoma in a 16 Months Old Child

Malignant melanoma in childhood and adolescence is rare but incidences have been seen to rise. Prognostic factors, risk factors and prognosis have similarities to melanoma in adulthood but paediatric melanoma presents a diagnostic challenge as it often lacks the classical features of adult pigmented malignant melanoma and histologically is difficult to diagnose. This case report describes a clinically atypical presentation of melanoma on the thigh of a 16 month old boy. Initially seen at five months old by a dermatologist were a punch biopsy of the element was made with histological diagnosis; unusual congenital nevus. The element hereafter evolved and at the time of diagnosis measured 7.5 mm in Breslow thickness. Sentinel node biopsy and full body scans were made with no sign of metastasis. Like other cases reported, the melanoma did not exhibit the classical characteristics of the ABCD criteria which may have played a part in delaying diagnosis. Studies suggest that delayed diagnosis in children is not uncommon and younger patients present with more advanced disease at the time of diagnosis. To facilitate earlier recognition of melanoma in children additions to the conventional ABCD criteria have been suggested. This report illustrates that malignant melanoma should always be taken into consideration when presented with lesions of the skin and that a high level of clinical awareness and suspicion is required in order to hasten diagnosis and maybe improve prognosis in cutaneous malignant melanoma in children and adolescents.