Needs, distress, state-of-health and quality-of-life in survivors of stage III melanoma: results from the cross-sectional MESSAGE study

Background: Pediatric melanoma, defined as melanoma occurring in individuals under the age of twenty, is extremely rare.However, it remains the most common skin cancer in children.Although the incidence of melanoma in children and young adults is declining, it is estimated to account for 3% of pediatric cancers Methods: We present four clinical cases of pediatric melanoma.The cases involve two 13-year-old girls, a 13-year-old boy, and a 14year-old boy, all of whom exhibited distinct types of lesions.One case involved a congenital nevus that had undergone noticeable changes; another case presented as melanonychia; a third case was characterized by a multiple color nevus; and the fourth case involved a highly vascularized reddish dorsal papule.The lesions were excised with a preliminary diagnosis of atypical nevi, except for the last case, which was initially suspected to be a pyogenic granuloma.Results: Histopathological examination revealed nests of highly atypical melanocytic cells, including some epithelioid cells with numerous mitoses.Immunohistochemical studies were performed in all cases, showing positive results for PRAME, SOX10, and S100, among others.The Breslow thickness of the melanomas ranged from 0.3 mm to 2.3 mm.The subungual melanoma was classified as in situ.Margin extension surgery was performed in all cases, along with sentinel lymph node biopsy in one case, which yielded a negative result.Extension studies found no evidence of distant metastasis.All patients remain under follow-up in our department without signs of recurrence or distant metastasis.Conclusions: Pediatric melanoma is uncommon in our clinical practice, though cases have been described in the literature.Three types are distinguished: melanoma arising from a congenital melanocytic nevus, spitzoid melanoma, and conventional melanoma.Our series includes representatives of each type, along with a case of subungual pediatric melanoma.The low clinical suspicion due to the age group, combined with the frequently amelanotic presentation of spitzoid melanoma, complicates diagnosis.Staging and follow-up in these patients are challenging due to their rarity, the potential effects of radiation and the lack of guidelines.Reporting such cases may assist dermatologists when confronted with this clinical challenge.