Application Guidelines Congenital Melanocytic Nevi And Acquired Congenital Pattern Melanocytic Nevi

Introduction

During the past two decades there has been a great deal of discussion and investigative effort expended regarding the definition and role of congenital moles as precursor lesions for malignant melanoma in children. Contrary to reports in the older literature, 0.3 to 0.5% of all melanomas occur in children under age 13 years. Although childhood melanoma is rare, there is no absolute safe age range. About two-thirds of childhood melanomas arise de novo and these tumors have a biological course and potential similar to adult melanomas of similar thickness, level and staging. Approximately 3% of childhood melanomas arise in a large congenital melanocytic nevus (also called "giant nevus," "garment nevus," and "bathing trunk nevus"), and half of these occur by age 3 years. Because the malignancies often arise deep in the nevus, clinical signs are often absent until after spread has occurred, and the overall 5-year survival figures are abysmal. The focus on these large precursor lesions has spawned a raging debate over the lifetime malignant potential of more commonly occurring small and medium-sized congenital melanotic moles that are clinically and histologically similar to the larger ones. Subsequent studies have identified an even more common acquired childhood nevus that shares clinical and microscopic features with those that are present at birth. These acquired "congenital pattern" moles may, because of their frequency, be more important as an overall lifetime melanoma precursor. This is a complicated issue, which must be handled in an open yet sensitive fashion. At this time the potential of the large congenital nevi is fairly well established. Statistics regarding the true malignant threat from small and medium congenital nevi and the acquired lesions are still speculative. Therefore, there are no hard and fast answers in regard to treatment. Because these are often striking lesions, the question regarding their proper treatment will arise with some frequency in any practice that sees a significant pediatric population.

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