PA02 A teenager with a bleeding neck nodule

Abstract A 14-year-old boy was referred to dermatology with a new bleeding lesion on his right neck that had grown rapidly. There no preceding history of trauma. Physical examination revealed discrete eroded pink nodule measuring 10 × 9 mm neck. Dermoscopic showed central area ulceration, polymorphous vessels, white lines and multiple shades milky-white areas. This excised. Histology confirmed the diagnosis ulcerated superficial spreading malignant melanoma Breslow thickness 4.8 (pT4b). BRAF v600e mutation present. Initial staging sentinel lymph node biopsy whole-body positron emission tomography/­computed tomography were clear, but 6 months after presentation, he developed right-sided cervical lymphadenopathy parotid mass be metastatic disease. Following parotidectomy dissection, commenced adjuvant treatment dabrafenib trametinib. He remains under close follow-up. Less than 1% all melanomas are diagnosed in patients younger 20 years age. Most paediatric cases occur adolescence (between 15 19 age). The majority arise sporadically. Risk factors for childhood include giant congenital melanocytic naevi, personal malignancy, family melanoma, (> 50) sunburn or tanning-bed use, immunosuppression genodermatoses (e.g. xeroderma pigmentosum). clinicians familiar ‘ABCDE’ tool (asymmetry, border irregularity, colour variegation, diameter > mm, evolution) used help recognition melanomas; however, children often presents an atypical fashion. Paediatric lack pigment (amelanotic) nodular, so may misdiagnosed. Because this, delayed present thicker tumours involvement. To facilitate earlier diagnosis, modified ABCD detection criteria have been proposed (amelanosis, bleeding/bump, uniformity, de novo development) can conjunction established ABCDE approach. CUP also described (colour is pink/red/changing, ulceration/upward thickness, pyogenic granuloma-like lesions/pop-up lesions). Evolution important point consider when suspecting any Management adopted from American Joint Committee Cancer system guidelines adult melanoma. Currently, there specific management children. mainstay surgical resection. Sentinel should considered ulceration 0.75 mm. Patients stage III IV immunotherapy. All followed-up regular skin examinations.