Historical Perspective: Conti et al., 2001; Fabrizi and Massi, 2001

Conti and co-workers, also in 2001,82 analyzed 212 cases of melanoma in children 14 years of age or younger who had been followed for a period of at least five years. Their patients were culled from the registries of 17 European countries that participated in the EUROCARE database during the interval between 1978 and 1989. They sought to obtain data about survival and other information for the purpose of generating statistics. No histopathologic findings were presented or pictured. Conti and associates stated this about the relationship of age and prognosis:
"Overall survival for all was generally good (79%, 95% confidence interval (CI) 60–91), with no differences between gender. Some survival differences emerged when the age classes were considered separately: survival was lower in boys diagnosed in the age range 10–14 years (64%; 95% CI 43–81 at 5 years) and 1–4 years (42%; 95% CI 25–62 at 5 years)."
The collaborators concluded thus:
In children, survival for MM [malignant melanoma] is slightly different to that of adults. Since the natural history of the disease is not influenced by age, a better prognosis in children is probably due to the early radical removal of pigmented skin lesions, a situation favored by the greater awareness of parents and physician of the dangers of melanoma and also because of the antiaesthetic features of skin lesions."
In 2001, Fabrizi and Massi83 wrote about what they called melanoma of the "spitzoid" type in teenagers. One melanoma that developed on the leg of a 15-year-old boy was diagnosed initially as "Spitz nevus." Five years later, the patient developed metastases of melanoma to regional lymph nodes, lungs, and brain. He died eight years after the erroneous diagnosis of Spitz's nevus was made. The other patient was a 19-year-old whose lesion on the back was diagnosed as a "spindle cell-type Spitz naevus." Fifteen years later, he developed signs of metastases of melanoma to the skin of the back, the retroperitoneum, and the pelvic bones. Predicated on knowledge gained from these two patients, Fabrizi and Massi offered these thoughts:
"As regards the nature of these lesions our cases point out that a fatal outcome can be provided if the patients are followed for long enough (one of the cases metastasized 15 years after the diagnosis) and the good prognosis proposed for these entities in the past has to be corrected.
In conclusion it seems that the diagnosis of a life-threatening melanoma should be made without hesitation if a combination of nuclear and nucleoloar pleomorphism, mitoses and growth in solid sheets of cells is found in a melanocytic neoplasm with features of a Spitz naevus in an adolescent."
Both teenage patients of Fabrizi and Massi had a melanoma that was misdiagnosed histopathologically as Spitz's nevus or an equivalent designation for it. Both lived with their metastases for years, one even for 15 years. These findings call into question the conclusion of Helwig 25 years before to the effect that melanomas in children have a better prognosis than do melanomas in adults and they indicate that melanomas in young persons have the same potential for metastasis as do melanomas in adults. Moreover, those metastases end in death irrespective of how closely the primary melanoma resembles a Spitz's nevus histopathologically.