(HealthDay News) — A considerable proportion of children with melanoma do not present with conventional melanoma detection criteria (asymmetry, border irregularity, color variegation, diameter >6 mm, and evolution [ABCDE]), according to a study published in the June issue of the Journal of the American Academy of Dermatology.

Kelly M. Cordoro, M.D., from the University of California in San Francisco, and colleagues conducted a retrospective study involving 60 children with a diagnosis of melanoma and 10 children with ambiguous melanocytic tumors treated as melanoma, diagnosed before age 20 from 1984 to 2009. The patients were categorized by age: 0 to 10 years (19 patients, group A) and 11 to 19 years (51 patients, group B).

The researchers found that 60% and 40% of groups A and B, respectively, did not present with conventional ABCDE criteria. The most common features included amelanosis, bleeding, “bumps,” uniform color, variable diameter, and de novo development. Significant between-group variation was observed in histopathological subtypes. Forty-four percent were considered histopathologically unclassifiable according to current melanoma subtypes.

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In groups A and B, 92% and 46% of patients, respectively, had stage IIA disease or higher (P = 0.05). One patient in group A and nine in group B died; 70% of these cases had amelanotic lesions and 60% had one or more major risk factors. Metastasis was predicted with Breslow thickness (adjusted odds ratio, 12.8).

“Additional ABCD detection criteria (Amelanotic; Bleeding, Bump; Color uniformity; De novo, any Diameter) used together with conventional ABCDE criteria may facilitate earlier recognition and treatment of melanoma in children,” write the authors.