Dados do Trabalho

Título

PEDIATRIC MELANOMA IN A 4-YEAR-OLD PATIENT: A CASE REPORT

Apresentação do caso

Female patient, 4-year-old, had skin material from the scalp submitted to anatomopathological analysis, which was compatible with the diagnosis of invasive malignant melanoma with infiltration into the subcutaneous cellular tissue, with Clark level 5 and Breslow thickness of 5.2 mm. The material was submitted to an immunohistochemical examination that confirmed the diagnosis.

Discussão

Pediatric melanoma occurs in patients ranging in age from in utero to 21 years. It is the most common skin cancer in children and adolescents, and yet it is a rare entity, with only 0.4% of cases and 0.1% of deaths from melanoma occurring in patients under 20 years of age. Pediatric melanoma can be subclassified into 3 categories: conventional, congenital melanocytic nevus-derived, and spitzoid. Differentiating between these subtypes is important as each of them has different treatment options, risk factors, and
histological findings. Diagnosis of this type of skin cancer in children is generally challenging, as its clinical presentation can be quite nonspecific and the lesions can resemble benign nevus, dysplastic nevus, hemangiomas, Spitz nevus, pyogenic granulomas or warts. A high index of suspicion is necessary when evaluating children. Dermatoscopic examination is important to visualize the morphologic features of pigmented and nonpigmented lesions to differentiate melanoma from nevi. Full- thickness biopsy is indicated for suspicious lesions. Excisional biopsies are recommended for concerning lesions. Shave biopsies can interfere with pathologic
diagnosis and accurate measurements of Breslow thickness. Overall survival for all patients with pediatric melanoma appears to be similar to that of adults. Unfavorable prognostic factors in children include male sex, regional or distant metastasis, nodular histology, increasing thickness of primary site, earlier year of diagnosis, and a history of previous cancer.

Comentários finais

The limited knowledge about this disease in children and adolescents represents an important obstacle not only in the diagnosis, but also in the definition of prognosis and management of patients. The diagnosis of melanoma in pediatric populations is often difficult due to the wide variation in the clinical and histological presentation of this entity, which is made even more difficult by the fact that physicians hardly suspect malignancy in dermatological lesions in this population group, which highlights the importance of this subject.

Palavras-chave

Malignant Melanoma; Skin Neoplasms; Immunohistochemistry.