ABCDE criteria non optimal for pediatric melanoma diagnosis

Feb 25 2013

By Helen Albert, Senior medwireNews Reporter

Conventional criteria for diagnosing melanoma may not be accurate in children and adolescents, suggest results published in the Journal of the American Academy of Dermatology.

A checklist of symptoms known as ABCDE - Asymmetry, Border irregularity, Color variegation, Diameter (>6 mm), Evolution (any morphologic or symptomatic change in the lesion) - are commonly used to give a first diagnosis of suspected melanoma.

However, while these criteria are largely accurate in the adult population, in the current study, 60% of children under the age of 10 years (group A) and 40% of adolescents aged 11-19 years (group B) with melanoma or ambiguous melanocytic tumors did not present with these features.

Kelly Cordoro (University of California, San Francisco, USA) and colleagues found that amelanosis, bleeding, presence of bumps, uniform color, variable diameter, and new development were the most common features associated with melanoma in the 70 children with melanoma or ambiguous melanocytic tumors whose data they analyzed.

Histopathologic features differed significantly between group A (n=19) and group B (n=51) patients. Overall, 47% of group A melanomas were unclassified or spitzoid and 32% were severely atypical ambiguous lesions, whereas group B lesions were mostly unclassified (53%). Conventional types of adult melanoma (acral, superficial spreading, nodular) were more common in group B than group A, at 28% versus 16%.

Group A lesions were also much more likely to have a Breslow thickness greater than 1 mm, at 92.9%, and be classed as stage IIA disease or above, at 92.0%, compared with 59.6% and 46.0% of the lesions seen in group B, respectively.

The most common features associated with melanoma in group A were amelanosis (77%), lesional bleeding, raised bumpy lesions, uniform color (87%), and new development. Similar characteristics were observed in group B although amelanosis and uniform color were less common (23% and 49%, respectively).

The researchers suggest that additional ABCD criteria (Amelanotic; Bleeding, Bump; Color uniformity; De novo, any Diameter) could be used in addition to current ABCDE criteria to make early recognition, diagnosis, and treatment of melanoma easier in children and adolescents.

"Applying both sets of criteria may facilitate earlier detection by modifying the overall concept of how melanoma may present in children," say Cordoro and team.

"Children with suspicious lesions even without well-recognized risk factors should be treated with an elevated baseline level of awareness," they suggest.

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