Abstract

Introduction: Pediatric atypical melanocytic tumors (AMT) are understudied, with limited data on treatment and long-term outcomes. This single-institution retrospective cohort study examines pediatric melanoma (PM) and AMTs, adding to the literature for these rare entities. Methods: We reviewed cases of PMs and AMTs in pediatric patients (age 0-18 years) over twenty years (January 2002-December 2022). EPIC SlicerDicer function was used for patient identification in this study. Data were analyzed using descriptive statistics. Results: Over two decades, there were 55 cases of PM (53 patients) with a median follow-up duration of 8 years 11 months. 96% were treated with wide local excision (WLE), and 47% has sentinel lymph node biopsy (SLNB) with a 35% positive rate. 8% of patients died with disease. There were 101 cases of atypical Spitz proliferations (85% atypical Spitz tumors, 15% Spitz melanoma) with a median follow-up duration of 9 years. 77% were treated with WLE and 15% had SLNB with a 20% positive rate. One patient died of metastatic disease. There were 10 cases of AMTs not otherwise specified: 5 pigmented epithelioid melanocytomas, 4 deep penetrating nevi, and an atypical cellular blue nevus. Conclusions: This study adds to the growing literature on pediatric AMTs, consistent with previously described characteristics such as high overall survival rates and anatomic location of disease across tumor subtypes, with distinct exceptions like higher melanoma SLNB positive rate, lower WLE rate for atypical Spitz tumors, and a case of fatal metastatic Spitz melanoma.