Malignant melanoma in a black child: Predisposing precursors and management

• Published in: Journal of the National Medical Association Vol. 96; no. 10; pp. 1368 - 1373
• Main Authors: ADEDOYIN, Olanrewaju T, JOHNSON, Abdul-Wahab B. R, OJUAWO, Ayodele I, AFOLAYAN, Enoch A. O, ADENIJI, Kayode A
• Format: Journal Article
• Language: English
• Published: Thorofare, NJ Slack 01.10.2004; Elsevier Limited; National Medical Association
• Subjects: African Continental Ancestry Group - genetics; Biological and medical sciences; Causality; Child, Preschool; Dermatology; Dysplastic Nevus Syndrome - complications; Dysplastic Nevus Syndrome - congenital; Dysplastic Nevus Syndrome - ethnology; Female; General aspects; Humans; Lymph Nodes - pathology; Medical sciences; Melanoma - diagnosis; Melanoma - drug therapy; Melanoma - ethnology; Melanoma - etiology; Nigeria; Risk Factors; Skin Neoplasms - complications; Skin Neoplasms - congenital; Skin Pigmentation - genetics; Tumors of the skin and soft tissue. Premalignant lesions; Nigeria; Human; Skin disease; risk factors; Nevus; Malignant tumor; Epidemiology; Precursor; Primitive; Treatment; Risk factor; Malignant melanoma; Primary; giant hairy nevus; Tropical medicine; Child; primary malignant melanoma
• ISSN: 0027-9684; 1943-4693

Malignant melanoma (MM) remains a pediatric rarity world-wide, but perhaps more so in black Africans. To the best of our knowledge, the current report of MM in a two-and-a-half-year-old Nigerian who had a pre-existing congenital giant hairy nevus is probably the first (in an accessible literature) in a black African child. Primary neoplastic transformation and metastatic spread were suggested by the appearance of multiple swellings over the "garment" precursor nevus at the posterior trunk, multiple ipsilateral axillary nodal enlargement, and fresh occipital swellings postadmission. Smaller-sized hyperpigmented lesions with irregular, nonlobulated, and frequently hairy surfaces were also discernible over the upper and lower extremities, but the face, anterior trunk, and mucosal surfaces were relatively spared. A diagnosis of MM was confirmed by the subsequent histopathologic findings from the fine-needle aspirate and biopsy specimens. Chemotherapy was initiated but was truncated shortly after by parent-pressured discharge. Despite the rarity of MM in a tropical African setting where management options are few, the current case underscores the need for a high clinical index of diagnostic suspicion, an early pursuit of investigative confirmation, and prophylactic excision in children with the predisposing skin lesions, like congenital giant hairy nevus. An expounded discourse of the possible precursors and management options of MM is provided. We emphasize the need for institutional cost subsidy for anticancer care in tropical children.