ABCDEs of melanoma not applicable to all patients

Many pediatric patients with melanoma do not demonstrate symptoms falling within the ABCDE detection criteria, researchers say.

In a retrospective study, investigators with the University of California, San Francisco, studied 60 pediatric patients with melanoma and 10 pediatric patients with ambiguous melanocytic tumors treated as melanoma. Patients were diagnosed before age 20, from 1984 to 2009. Patients were grouped as group A for ages 0 to 10 and group B for ages 11 to 19, according to the study.

Sixty percent of patients in group A and 40 percent in group B did not present with conventional ABCDE (asymmetry, border irregularity, color variegation, diameter > 6 mm and evolution). Instead, amelanosis, bleeding, “bumps,” variable diameter, uniform color and de novo development were most common, researchers found.

“Histopathological subtypes differed significantly between groups (P=0.002). In all, 44 percent were histopathologically unclassifiable using current melanoma subtypes,” study authors wrote.

Stage 2A disease or higher comprised 92 and 46 percent of groups A and B, respectively (P=0.05). One patient in group A died and nine in group B died. Of the patients who died, 70 percent had amelanotic lesions, and 60 percent had at least one major risk factor. Breslow thickness predicted metastasis (adjusted odds ratio, 12.8 [confidence interval 1.4-115]).

The findings were published in the Journal of the American Academy of Dermatology.

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