Juvenile melanoma
Features
These lesions are compound naevus variants, which are seen most commonly in children. They have distinctive pathological features that make them very difficult to distinguish from malignant melanoma.
Clinically, spitz naevi are rounded, blanching, pigmented (red to brown) lesions, with a small proportion showing a surrounding halo. They usually appear in the early years of childhood and can grow rapidly over 3-6 months to reach 1-2cm in diameter, after which they may remain static in size. The overlying epidermis is fragile and can bleed and crust following minor trauma.
The face and legs are the most commonly affected sites. Although most commonly seen in children and young adults (up to people in their twenties), they may occur at any age.
Incidence
Relatively rare. Equal incidence in males and females. People of Black and East Asian descent seem to have a lower incidence.
Aetiology
Compound naevus variant of unknown aetiology.
Differential Diagnosis
Malignant melanoma. Pyogenic granuloma. Dermatofibroma. Spindle cell naevus of Reed. Compound naevus.
Treatment
Escision with a 1-2mm margin of normal skin is indicated. The excised lesion should be sent for histology, but it is notoriously difficult for pathologists to distinguish between spitz naevi and malignant melanoma without knowing the age of the patient and clinical appearance of the lesion. Local recurrence following excision has been reported.