Journal of the American Academy of DermatologyVolume 30, Number 3 Briefcommunications 493

Malignant melanoma in a child

Fig. 1. Lesion on the right calf.

Serap Ozturkcan, MD,a Fahrettin Gaze, MD,b Nilgiin Atakan, MD,d and Fevzi ir;li, MDcSivas and Ankara, Turkey

Malignant melanoma (MM) is uncommon inchildren and young adults and is particularly rarebefore puberty. 1,2 Approximately 2% ofMMs occurin patients younger than 20 years of age'; 0.3% to0.4% of cases occur in prepubescent children.s" Atrisk for developing childhood MM are patients withxeroderma pigmentosum, congenital melanocyticnevi (CMN), acquired nevi with a congenital histo­logic pattern, and those with a family history ofMM.l-S

The tendency to develop MM in large CMN iswell known" but little attention has been given toMM arising in small CMN. We report a case ofMM in a small CMN in a prepubescent child.

CASE REPORT

A 9-year-old white girl had a congenital nevuson theright calf that had recently increased in size. There wasno family history of atypical or congenital nevi.

Examination revealed a lOX 8 X 3 mm black noduleand almost no remnant of the congenital nevus (Fig. I).Lymphadenopathy was absent. The lesion was excisedwith a 3 em margin.

Histopathologic examination revealed a melanocyticprocess composed of fusiform cells extending from thedermoepidermal junction into the reticular dermis. Theepidermis was not involved but was atrophic. There wasbrown pigment in the stratum corneum. Examination ofthe papillary dermis revealed nesting of nevuscells in thewalls of eccrine ducts and hair follicles (Fig. 2), the fea­tures ofa congenital nevus,"The tumor extended into thereticular dermis (Clark level ITT). Its greatest thicknesswas 2 mm. Mitotic figures averaged one per high-powerfield. Asparse lymphocyticinfiltration waspresentaroundthe tumor.

DISCUSSION

Large CMN (more than 10em in diameter) havean increased risk for the development of MM before

From the Departments of Dermatology." Pathology," and General Sur­gery," Cumhuriyet University and thc Department of Dermatology,"Haceteppc University.

Reprint requests: Scrap Ozulrkcn». MD, Department of Dermatology,Cumhuriyet University, Faculty of Medicine, Sivas, Turkey.

JAM ACAD DERMATOL 1994;30:493-4.

Copyrlght e' 1994 by the American Academy of Dermatology, Inc.

0190-9622/94 $3.00 + 0 16/54/49907

puberty.r" Because the lifetime risk of malignanttransformation is estimated to be at least 6.3%, earlyexcision of large CMN is recommended.f

Because it occurs in 1% of all births, small CMN(less than 3 cm in diameter) is 200 times more com-

494 Briefcommunications

mon than large CMN (1%vs. 0.005%).9 Rhodes andassociates'? estimated a cumulative melanoma riskof 2.6% to 4.9% for persons with a small CMN (lessthan 10 em in diameter). Illig et al. l l suggested thatthe small CMN is a potential precursor of MM andprophylactic excision might be the treatment ofchoice. However, the malignant potential associatedwith small eMN is still controversial. 8, '0, 12, 13 Asmall CMN as a precursor of MM must be docu­mented by parents' statement, photographs, or med­ical records, and confirmed by showing a remnant ofthe congenital nevus histologically. Distinguishing asmall CMN from an acquired nevus isdifficult, buta CMN is more likely to have nevus cells in the lowertwo thirds of the reticular dermis and to showinvolvement of dermal appendages and neurovascu­lar structures."

It has been estimated that only one of every170,000 cutaneous MMs arises in direct contiguitywith a small CMN.IO Consensus on preventive ex­cision has not been reached, and the tendency is topostpone excision until the onset of puberty.14, 15

REFERE:"\CES

1. Lee S. Skin cancer. In: Ruiz-Maldonado R, Parish LC,Beare .1M, eds. Textbook of pediatric dermatology. WBSaunders: Philadelphia, 1989:756-66.

2. Tarnopolsky R, Abramsohn L, Min KW. Facial malignant

Journal of the American Academy of DermatologyMarch 1994

melanoma in a 3-year-old child. JAOA 1988;88:1231-2.3. Roth ME, Orant-Kels .1M,Kuhn MK, et al. Melanoma in

children. .I AM ACAD DERMATOL 1990;22:265-74.4. Melnik MK, Urdaneta LF, AI-lurf AS, et al. Malignant

melanoma in childhood and adolescence. Am Surg1986;52:142-7.

S. Trozak OJ, Rowland WD, Hu F. Metastatic malignantmelanoma in prepubertal children. Pediatrics 1975;55:191­204.

6. Kopf AW, Bart RS, Hennessey P. Congenital nevocyticnevi and malignant melanomas. J AM ACAD DERMATOL1979;I:123-30.

7. Rhodes AR, Silverman RA, Harrist TJ, et al. A histologiccomparison of congenital and acquired nevomelanocyticnevi. Arch Dermatol 1985;]21:1266-73.

8. Rhodes AR, Melski.lW. Small congenital nevocellular neviand the risk of cutaneous melanoma . .I Pediatr 1982;100:219-24.

9. Walton RO, Jacobs AH, Cox A.I. Pigmented lesions innewborn infants. Br J Derrnatol 1976;95:389-96.

10. Rhodes AR, Sober AJ, Day CL, et al. The malignant po­tential of small congenital nevocellular nevi. J AM ACADDERMATaL 1982;6:230-41.

II. Illig L, Weidner F, Hundeiker M, et al. Congenital nevi<10 cm as precursors to melanoma. Arch Derma tol1985;121:1274-81.

12. Alper JC. Congenital nevi: the controversy rages on. ArchDerrnatol 1985;121:734-5.

13. Elder DE. The blind men and the elephant: different viewsof small congenital nevi.Arch Dermatol 1985;[2\:1263-5.

14. Stegmaier OC, Becker SW Jr. Incidence of melanocyticnevi in young adults . .I Invest Derrnatol 1960;34:125-9.

15. Rhodes AR. Pigmental birthmarks and precursor melano­cytic lesionsof cutaneous melanoma identifiable in child­hood. Pediatr Clin North Am 1983;30:435-63.

Multiple plantar epidermoid cysts harboring carcinoembryonic antigen andhuman papillomavirus DNA sequences

Kiyofumi Egawa, MD,a Yumi Honda, MD,a Youichi Inaba, MD,a Yasuko Kojo, MD,hTornomichi Ono, MD,a and Ethel-Michele de Villiers, Phl)" Kumamoto, Japan, andHeidelberg, Germany

It has long been assumed that epidermoid cysts inthe palm or sole result from the deep implantationof a fragment of epidermis from a blunt penetrating

From the Department of Dermatology, Kumamoto University Schoolof Medicine," Dermatology Section, Kumamoto Chuo Hospital," andReferenzzcntrum fUr humanpathogene Papillomviren, DeutchesKrebsforschungszentrum."

Reprint requests: Kiyofumi Egawa, MD, Department of DermatologyKumamoto University School of Medicine, 1-1-1 Honjo, 860 Ku­mamoto, Japan.

JAM ACAD DERMATOL 1994;30:494-6.Copyright cc; 1994 by the American Academy of Dermatology, Inc.

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injury.' However, this assumption has been ques­tioned.i The induction of cyst formation by kerati­nocytes after papillomavirus CPY)infection has beendescribed in rabbits and given the descriptive name,"cystic papilloma."? This suggests the existence of asimilar mode of PV infection in other species such ashumans. Recently we demonstrated human PY(HPV) in plantar'l- ' and palmar" epidermoid cystsand proposed a direct role for HPV in the develop­ment of the epidermoid cysts.

We describe a patient with multiple plantar epi­dermoid cysts that contained eccrine ducts and HPVDNA.