Melanoma evolving pattern

[Annie_777]

Hi, my 5 y/o son has been urgently referred to pediatric dermatology at a local hospital.  While we wait for his appointment, I'd like to be educated.

He is Asian - which puts him in 50% chance of ALM, the most aggressive form.  What we observed during past 3-4 weeks include doubling in size of the irregular lesion, and an elevation of about 0.6mm from previously flat surface.  It was tender to touch but now presents persistent pain.  I'm very worried.  Is the height of elevation above the skin in any way predictive of the depth of penetration below the surface?

What percentage of likelihood that the growth my son experienced was benign growth?

Site of lesion on the side of 3rd toe towards 4th toe.  Size of lesion 6mm x 2-3mm, itregular border, with black centered elevation, and brown color regression at the edge.

[Annie_777]

Thank you again for all the help and information you provided for my son!  Without it, we will not be able to get the early appt @UCSF.  I will certainly update you w/ high res dermatoscopic image and his final path report.

[Annie_777]

Thx! I just bought the DermScope iPhone app.  I will take my son to his doctor's office today again, and borrow their dermatoscope, and try the blue inks to see if we can produce a better resolution picture.  Please check you private msg.

[maatson]

It may be difficult to distinguish the furrows(Benign) and ridges(malignant)- ie on the volar skin.
However, for the clinician to determine if a pigmented volar melanocytic lesion is benign or malignant, he or she has to correctly identify the furrows and ridges and has to determine which of these structures the pigmentation follows.
December 2008, Vol 144, No. 12 >

Observation | December 2008
The Furrow Ink Test
A Clue for the Dermoscopic Diagnosis of Acral Melanoma vs Nevus FREE
Ralph Peter Braun, MD; Luc Thomas, MD, PhD; Isabel Kolm, MD; Lars E. French, MD; Ashfaq A. Marghoob, MD
[+] Author Affiliations
Arch Dermatol. 2008;144(12):1618-1620. doi:10.1001/archderm.144.12.1618.
Do keep me informed.Emails do not get printed here but do keep contact with my My MedHelp profile.
M.

[Annie_777]

Does acral junctional nevus show parallel ridge pattern?  I took a picture of my son's lesion and blow it up - it appears to be a clear parallel ridge pattern.  If you give me your email, I can send you the picture in which I also marked the area of his recent growth.

[maatson]

While I was quite aware of the criterion met for the evolution of the lesion to a melanoma an infected acral junctional nevus is a look alike, and I am betting on to that and sincerely hope I am right.
Best wishes.

[Annie_777]

Juctional nevus should be flat right?  My son's nevus looks like a compound or combined acral nevus.  I hope that we can get the path report soon.  I read that ALM in children under 10 years old is rare but very aggressive and may start spreading at a much smaller dimension.  We'll see what this is.  If it is ALM, you will probably see a case report in academic journals from ped derm/derm path profs @UCSF.

[Annie_777]

The lesion has been there for > 1.5 years, started from a black thin streak, gradually expanding mostly in width and slightly in length.  However, we observe pretty aggressive changes during the past month.  The partially elevated part is black, and the edges are uneven, asymmetric with a lighter brownish shade.  It meets all but dimesion of the ABCDEF criteria (evolving/elevation, feeling).

He has an appt w/ Dr. Ilona Frieden at UCSF Medical Center next week.  She took a look at the picture of my son's lesion and decided to doublebook him in right away.  Dr. LeBoit at UCSF derm path is a student of Bernard Ackerman.  I hope that by working together, they will provide an accurate diagnosis soon.  Will keep you posted.

[maatson]

The age makes me think in favor of my diagnosis.Dermatoscopy and biopsy should confirm.Your consultants should give you their opinion.
Do keep me informed.

[maatson]

Are we looking at Acral junctional nevus which has got secondarily infected? I hope so.

Arch Pathol Lab Med. 2011 Jul;135(7):847-52.
Acral junctional nevus versus acral lentiginous melanoma in situ: a differential diagnosis that should be based on clinicopathologic correlation.
Bravo Puccio F, Chian C.
Source
Department of Pathology, Alberto Hurtado School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru. ***@****
Abstract