Melanoma in children and adolescents

Despite its overall rarity, the incidence of melanoma in childhood and adolescence (i.e. before the age of 18 years, appears to have increased significantly over the past decades). This has particularly affected post-pubertal children and adolescents, while melanoma in pre-pubertal children remains exceptional. Whites are predominantly affected and there appears to be a slight female predilection. Sun sensitivity as well as excess sun exposure appear to be major aetiological factors, and the presence of multiple naevi, including dysplastic naevi, and a positive family history for melanoma incurs an increased risk. Other important but rare associations include xeroderma pigmentosum, immunosuppression, radiation and a genetic predisposition. Due to the rarity of the disease and its frequently unusual presenting features, the diagnosis of melanoma in children is often challenging, resulting in a potential delay of treatment. The histological spectrum of childhood melanomas is wide, and firm diagnostic criteria are difficult to establish. Tumours in young children and those showing ‘Spitzoid’ morphology in particular pose a diagnostic dilemma. Awareness of the entity and its presenting features is necessary for accurate diagnosis and treatment. Caution is however warranted before rendering a definitive diagnosis of melanoma in childhood with all its associated implications.