A Comprehensive Approach to Pediatric Atypical Melanocytic Neoplasms with Comment on the Role of Sentinel Lymph Node Biopsy.

Abstract

Pediatric melanoma has been rising in incidence in recent years and its management poses challenges that are frequently exacerbated by diagnostic uncertainty about the benign or malignant nature of many pediatric melanocytic neoplasms. Sentinel lymph node biopsy (SLNB), originally described by Dr. Donald L. Morton, has been incorporated selectively into the management of pediatric atypical melanocytic neoplasms (AMNs), but its value and significance in this scenario have been controversial. Herein, we describe a comprehensive approach to the evaluation and management of pediatric AMNs that involves SLNB as a diagnostic, staging, and potentially therapeutic tool. We also describe our approach to educating patients and their families about the inherent uncertainties involved in diagnosing and predicting the ultimate behavior of pediatric melanocytic lesions. In addition, we stress the importance of long-term follow-up, as well as ongoing research to improve our understanding of the prognostic factors and histopathologic characteristics that may one day allow us to minimize or eliminate entirely this diagnostically uncertain category of skin lesions.