Sentinel node biopsy for melanocytic tumors in children

Sentinel node biopsy is as pivotal for the staging of pediatric melanoma patients as it is for adults. However, pediatric patients frequently present the clinician with pigmented lesions—such as atypical Spitz tumors or Spitzoid melanomas—that are not easy to classify as benign or malignant, and often fall into a diagnostic gray area when assessed with light microscopy alone. For these lesions, the performance of sentinel node biopsy can contribute to an understanding of the lesion's biology. We present a strategy for incorporating sentinel node biopsy into the overall management approach to children with atypical pigmented lesions with features suspicious for melanoma. With the inclusion of additional adjunctive techniques such as comparative genomic hybridization, this algorithm may lend more diagnostic precision to difficult-to-classify lesions.