Clinical picture of malignant melanoma in children
Czerwiński, W.; Kozera, M.
Pediatria Polska 61(8): 534-542
1986
ISSN/ISBN: 0031-3939 PMID: 3575004 Document Number: 276339
The incidence of malignant melanoma in children is lower than in adults, and this neoplasm accounts for only a fraction of percent of all childhood neoplasms. Malignant melanoma grows in normal skin, in non-malignant cutaneous naevi or in giant naevi, which is a characteristic feature of childhood. The gross appearnace of malignant melanoma may be related to the level of skin invasion. From this standpoint the three-grade classification was considered: LM, SSM and NM. The last grade has the poorest prognosis. The most frequent locations of the primary focus of the neoplasm in children are: the head, the neck and the trunk. The rate of tumour spread is high. It spreads by infiltration of neighbouring tissues and structures with development of satellitary foci, via the lymph vessels it metastasizes to the regional lymph nodes, and via the blood vessels it gives secondaries to the lungs, liver, bones and brain, most frequently. In cases with a dramatic course it spreads by all these ways. The diagnosis is based, on clinical, radiological, scintigraphic and CT findings. The ultimate diagnosis is provided by histological examination which should also determine the depth of skin infiltration (Clark) or infiltration thickness (Breslow). surgical management with radical removal of the primary tumour is the method of choice. Simultaneous removal of regional lymph nodes depends on the degree of tumour progression. In view of unsatisfactory results of melanoma treatment in more advanced cases the operation is followed by chemotherapy from the third level of infiltration on in grade I lesions, and in all higher grades of clinical progression In our own material out of 18 treated 10 are alive: 7 over 3 years and 4 over 5 years. The longest survival is 14 years.