Is this mole on a boy's arm cause for concern?

The mother of an 8-year-old boy is concerned about the shape and color of a mole that has developed on her son’s arm during the last few months. The lesion is asymptomatic.

What do you suspect?

A. Benign nevus.

B. Dysplastic nevus.

C. Spitz nevus.

D. Seborrheic keratosis.

E. Melanoma.

(Answer and discussion on next page)

ANSWER—Case 4: Spitz nevus

A punch biopsy revealed the lesion to be a benign spindle cell nevus, or Spitz nevus, C.

Dysplastic nevi and melanomas are exceedingly rare in children; however, they do occur and should be included in the differential. Seborrheic keratoses also are rarely seen in children.

Cryosurgery is not recommended for melanocytic lesions; the procedure makes it difficult to follow pigmentary changes. Wide excision is never indicated in the absence of a histologic diagnosis. Checking the lesion at 4- to 6-month intervals is an option. However, accurate assessment of the changes in pigmented lesions is subjective and makes it difficult to decide when biopsy is indicated.