Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Surg Proced. Nov 28, 2015; 5(3): 229-234
Published online Nov 28, 2015. doi: 10.5412/wjsp.v5.i3.229
Malignant melanoma in the pediatric population
John Psaltis, Eric Reintgen, Ali Antar, Mark Giori, Leah Alvin, Alyssa Benjamin, Bridget Budny, Taylor Gianangelo, Aaron Gruman, Anna Stamas, Michael Reintgen, Rosemary Giuliano, Jeff Smith, Douglas Reintgen
John Psaltis, Eric Reintgen, Ali Antar, Mark Giori, Leah Alvin, Alyssa Benjamin, Bridget Budny, Taylor Gianangelo, Aaron Gruman, Anna Stamas, Michael Reintgen, Rosemary Giuliano, Douglas Reintgen, Department of Surgery, Morsani School of Medicine, University of South Florida, Tampa, FL 33612, United States
Jeff Smith, Department of Pathology, Florida Hospital - N Pinellas, Tarpon Springs, FL 34689, United States
Author contributions: All authors contributed to this manuscript.
Institutional review board statement: This study was approved by the University of South Florida Institutional Review Board - 6/2015.
Informed consent statement: Informed consent was obtained from the parents of the children described in the study.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Douglas Reintgen, MD, Department of Surgery, Morsani School of Medicine, University of South Florida, MDC 52, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, United States. dreintge@health.usf.edu
Telephone: +1-813-4408554 Fax: +1-813-9059891
Received: May 20, 2015
Peer-review started: May 21, 2015
First decision: June 18, 2015
Revised: July 1, 2015
Accepted: September 7, 2015
Article in press: September 8, 2015
Published online: November 28, 2015
Abstract

Controversial pigmented lesions in children are a problem for pathologist, clinicians and families that are confronted with this dilemma. Some skin lesions in this population defy diagnosis with pathologists split between a benign diagnosis and a cancer diagnosis. Three cases of controversial pigmented lesions in the pediatric population are presented. Three patients underwent radical resection of the controversial pigmented lesion, intra-operative lymphatic mapping and sentinel lymph node (SLN) biopsy. Due to the low morbidity of the SLN procedure a case is made to perform lymphatic mapping in this clinical scenario. If the SLNs are negative, not much is lost except for the scar and this becomes another line of evidence that perhaps the original lesion was benign. If the SLN shows metastatic cells, then the original skin lesion must be malignant and the patient is offered stage III recommendations that would include complete node dissections and adjuvant Interferon therapy. This strategy provides for adequate treatment of the worse-case scenario, that the skin lesion is malignant. The cost to the patient is a low morbidity procedure, the SLN biopsy.

Keywords: Pediatric pigmented skin lesions, Sentinel lymph node biopsy, Melanoma

Core tip: The sentinel lymph node staging procedure can be used to treat effectively pediatric patients with ambiguous pigmented skin lesions.