Published online Nov 28, 2015. doi: 10.5412/wjsp.v5.i3.229
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
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.
Core tip: The sentinel lymph node staging procedure can be used to treat effectively pediatric patients with ambiguous pigmented skin lesions.