Problematic melanocytic lesions in children

Melanocytic lesions in children are almost invariably benign and, consequently, their clinical management in most cases should be easy. There are, however, two problematic issues: one is the differential diagnosis between melanoma and Spitz nevus; the second is related to giant congenital melanocytic nevus. This is the most important risk factor for melanoma among children younger than 12 years of age, although less than 1% of children with congenital nevi will develop melanoma. Given that pediatric melanoma is extremely rare, most physicians will probably never be confronted with this malignancy. It appears that awareness related to the two previously mentioned problematic lesions is of greater utility, which would suggest immediate action in cases of new, rapidly growing lesions (the clinical hallmark of Spitz nevus) or in cases of congenital nevi with recent change in size, color and/or shape. In this review, we describe the most common clinical and dermoscopic features of a large spectrum of pediatric melanocytic lesions, with special emphasis on the problematic lesions that children may present.