Ewa Sawicka, Orest Szczygielski, Klaudia Żak, Paweł Pęczkowski, Elżbieta Michalak, Monika Bekiesińska-Figatowska
Clinic of Surgery of Children and Adolescents, Institute of Mother and Child, Warsaw, Poland
Med Sci Monit 2015; 21:123-132
Treatment of giant melanocytic nevi (GMN) remains a multidisciplinary challenge. We present analysis of diagnostics, treatment, and follow- up in children with GMN to establish obligatory procedures in these patients.
Material and Methods: In 24 children with GMN, we analyzed: localization, main nevus diameter, satellite nevi, brain MRI, catecholamines concentrations in 24-h urine collection, surgery stages number, and histological examinations. The t test was used to compare catecholamines concentrations in patient subgroups.
Results: Nine children had “bathing trunk” nevus, 7 had main nevus on the back, 6 on head/neck, and 2 on neck/shoulder and neck/thorax. Brain MRI revealed neurocutaneous melanosis (NCM) in 7/24 children (29.2%), symptomatic in 1. Among urine catecholamines levels from 20 patients (33 samples), dopamine concentration was elevated in 28/33, noradrenaline in 15, adrenaline in 11, and vanillylmandelic acid in 4. In 6 NCM children, all catecholamines concentrations were higher than in patients without NCM (statistically insignificant). In all patients, histological examination of excised nevi revealed compound nevus, with neurofibromatic component in 15 and melanoma in 2. They remain without recurrence/metastases at 8- and 3-year-follow-up. There were 4/7 NCM patients with more than 1 follow-up MRI; in 1 a new melanin deposit was found and in 3 there was no progression.
Conclusions: Early excision with histological examination speeds the diagnosis of melanoma. Brain MRI is necessary to confirm/rule-out NCM. High urine dopamine concentration in GMN children, especially with NCM, is an unpublished finding that can indicate patients with more serious neurological disease. Treatment of GMN children should be tailored individually for each case with respect to all medical/psychological aspects.
Keywords: Catecholamines - urine, Child, Child, Preschool, Disease Progression, Infant, Newborn, Magnetic Resonance Imaging - methods, Melanins - chemistry, Melanosis - urine, Neoplasm Metastasis, Neoplasm Recurrence, Local, Neurocutaneous Syndromes - urine, Nevus, Pigmented - urine