The Melanoma Letter

2018, Vol. 36, No. 3

In This Issue

From the Editors

Much has happened in the diagnosis and treatment of pediatric melanoma in the decade since we last covered the topic in depth in The Melanoma Letter. In this issue, six excellent contributors update us on advances in our understanding of the evolution of nevi in childhood, the use of dermoscopy in the diagnosis of pediatric melanoma and the application of the new exciting therapies for advanced metastatic melanoma in this age group.

In his lead story, Alon Scope, MD, reminds us of the well-established early recognition tools such as the ABCDEs of melanoma and the “ugly duckling” technique, also emphasizing the benefits of dermoscopic digital monitoring and total-body photography as aids to diagnosis. He elaborates on the lessons learned from the Study of Nevi in Children, or SONIC, which has documented the morphology and evolution of thousands of nevi during childhood and adolescence. By helping to establish patterns followed by ‘normal moles’ in this age group, the SONIC data inform recognition of outlier lesions that deserve greater clinical consideration. In a companion piece, Drs. Carrera and Marghoob explore the contribution of dermoscopy (which has been embraced as an indispensable tool in clinical assessment of pigmented lesions) to the diagnosis of melanoma in childhood.

In our concluding article, Drs. Sondak, Messina and Reed present the “Moffitt Five-Point Scale for Reporting Melanocytic Neoplasia,” which their group has developed to convey the risk of progression and metastasis associated with a given melanocytic lesion. They then explore how the revolutionary recent advances in targeted therapy (e.g., BRAF–MEK inhibition) and immunotherapy (e.g., checkpoint blockade) apply to the pediatric patient with advanced melanoma.

While melanoma incidence in childhood has risen, deaths remain few. Lowering this already low death rate while avoiding unnecessary biopsies, worry and morbidity will require further improvements in primary prevention, early diagnostic accuracy and therapy. We thank our authors for educating us about some of the most important advances in the field.

Allan C. Halpern, MD • Editor-in-Chief

Ashfaq A. Marghoob, MD • Associate Editor