Malignant Melanoma in Infancy

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Abstract
Although moles are frequently present at birth or become discernible shortly thereafter, malignant melanomas are rarely encountered at so early an age. Malignant tumors most frequently seen during the first five years of life are retinoblastomas, renal tumors (Wilms), and neuroblastomas of the adrenals or sympathetic nervous system, usually in the order mentioned (5). Other malignant neoplasms, including the melanomas, constitute only a small percentage of the total. Melanomas, as indicated above, may be present at birth, or they may make their appearance at any time during life. Many are first noticed shortly after puberty. It is doubtful that a nevus first recognized later in life is of recent origin; it is probably due rather to growth of a previously quiescent lesion. Only a small percentage of melanomas ever become malignant. It is, however, a well recognized fact that this type of lesion may undergo malignant change, especially when located where it is continuously exposed to irritation or trauma. In children this predisposing factor is insignificant, and hormonal stimulation has been suggested by some authorities as playing an etiologic role. The neval cells are melanoblastic and may or may not produce the pigment melanin. The embryological origin of these cells lies beyond the scope of this paper. They may be of neuro-tissue derivation, in which case the melanoma is superficially located, on the skin. The more deeply situated growths arise in mesoblastic connective tissue, are sarcomatous in nature, metastasize by way of the blood stream, and are more rapidly fatal. The three cases to be reported presented both diagnostic and therapeutic difficulties. Other points of interest will be brought up in the discussion following each case history. Case I: A white male infant five weeks of age was brought to us on May 31, 1944, because of numerous nodules present over its body. The mother stated that the tumors were present at birth, April 24, 1944. Since that time, several new lumps had appeared, while one or two of the others had become smaller. Delivery had been normal. The family history was negative for tuberculosis, syphilis, and malignant neoplasms. Two other children had been normal up to the time of death by accident. Examination revealed normal development and marked pallor of the skin. Most remarkable were the numerous masses distributed over the entire surface of the body, varying from one to several centimeters in diameter (Fig. 1). Some appeared to involve the skin, having a purplish-red color; others were more deeply situated and were covered by normal appearing skin. The consistency was rather firm, and the deeper tumors were firmly fixed to the surrounding tissues. The scrotum and prepuce were swollen and edematous, as was the left lower extremity. The lymph nodes of the left inguinal region were enlarged and were fixed to the underlying tissues.

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