741 Paediatric Pigmented Epithelioid Melanocytoma: A Case Report

Abstract

Abstract Background Pigmented epithelioid melanocytomas (PEMs) pose a challenge in terms of diagnosis and management, this is due to the wide spectrum of disease severity. Not only is management a grey area, but there is controversy over management and follow up, due to their indeterminate malignant potential. Case An 11-year-old boy presented with a six-month history of a rapidly changing pigmented naevus on his upper back. He had Fitzpatrick type 1 with no history of significant sun damage or familial history of skin cancer, and no relevant past medical history. Differential diagnoses included spitz naevus, malignant melanoma, or MelTUMP (melanocytic tumour of unknown malignant potential). An excision biopsy showed a benign pigmented epithelioid melanocytoma with local lymphatic involvement. The child was seen two months following the original surgery and no signs of local or regional recurrence was present. Discussion This is one of few cases of paediatric PEM reported in literature. This lesion has potential to metastasise through the lymphatics and mortality is very low. The management of PEMs is complicated due to their unknown malignant potential and should be decided by an MDT. Based on the limited literature on PEMs and our knowledge of ‘thin’ melanomas wide local excision is sensible, however a larger cohort if needed to fully understand prognosis. SNB should be considered on a case-by-case basis by an MDT, and regular ultrasound surveillance with clinical examination offers a safe alternative to SNB in some patients.