Clinical and Microscopic Evaluation of Pediatric Melanocytic Lesions

Introduction: Melanocytic lesions in children are unique challenging propositions both for the dermatologist and the pathologist. The potential for malignant change in melanocytic lesions is a cause for concern and distinction between benign nevus and malignant melanoma is crucial and at times can be extremely difficult. Aim: To decipher the clinicopathological spectrum of melanocytic lesions in Asian children because of rarity of such studies in our population. Materials and Methods: A retrospective analysis of all the cases diagnosed as melanocytic lesions in children less than 14 years of age was carried out between 1995 and 2014. The demographic data including the age at diagnosis, gender and site of lesion was compiled from the case files. Histopathological findings and final diagnosis rendered were also studied. Results: Skin and conjunctival biopsy specimens of melanocytic lesions from 27 pediatric patients formed the study group. The age at presentation ranged from 8 months to 14 years. The mean age at diagnosis was 10.28 years. Twelve (44.44%) lesions were from male children and 15 (55.56%) from female children. Majority, 18 (66.67%) were found in head and neck region. Of 27 childhood melanocytic lesions, 5 (18.52%) were benign pigmented lesions, 20 (74.07%) were benign nevi and 1 (3.70%) case each of non-giant congenital melanocytic nevus and Spitz nevus. No case of malignant melanoma was reported. Conclusion: Our data highlights the female predominance of pediatric melanocytic lesions, with benign nevi being the most common and head and neck a favored site. Pediatric melanoma although a rarity in Asian children, should not be missed and must be differentiated from atypical spitzoid lesions, the great mimickers of true melanoma.