Malignant MelanomainaBlack Child: Predisposing Precursors andManagement

Malignant melanoma (MM) remains apediatric rarity worldwide, butperhaps moresoinblack Africans. Tothebest of ourknowledge, thecurrent report ofMMinatwo-and-ahalf-year-old Nigerian whohadapre-existing congenital giant hairy nevus isprobably thefirst (in anaccessible literature) inablack African child. Primary neoplastic transformation andmetastatic spread were suggested bytheappearanceofmultiple swellings overthe"garment' precursor nevus attheposterior trunk, multiple ipsilateral axillary nodal enlargement, andfresh occipital swellings postadmission. Smaller-sized hyperpigmented lesions with irregular, nonlobulated, andfrequently hairy surfaces werealso discernible over theupper andlower extremities, buttheface, anterior trunk, andmucosal surfaces wererelatively spared. Adiagnosis ofMMwasconfirmed bythesubsequent histopathologic findings fromthefine-needle aspirate andbiopsy specimens. Chemotherapy wasinitiated butwastruncated shortly after byparent-pressured discharge. Despite therarity ofMMinatropical African setting where management options arefew, thecurrent caseunderscores theneedfor ahigh clinical index ofdiagnostic suspicion, aneardy pursuit ofinvestigative confirmotion, andprophylactic excision inchildren with thepredisposing skin lesions, like congenital giant hairy nevus. Anexpounded discourse ofthepossible precursors andmanagement options ofMMisprovided. Weemphasize theneedfor institutional cost subsidy for anticancer care intropical children.