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Large Congenital Melanocytic Nevi and the Risk for Development of Malignant Melanoma and Neurocutaneous Melanocytosis

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Large Congenital Melanocytic Nevi and the Risk for Development of

Malignant Melanoma and Neurocutaneous Melanocytosis

Flavia V. Bittencourt, MD*; Ashfaq A. Marghoob, MD‡; Alfred W. Kopf, MD*; Karen L. Koenig, PhD§; and Robert S. Bart, MD*

ABSTRACT. Objective. To determine the risk for de-veloping malignant melanoma and neurocutaneous melanocytosis (NCM) in patients with large congenital melanocytic nevi.

Design. Follow-up data suitable for calculations were available on 160 patients in the New York University Registry of Large Congenital Melanocytic Nevi who had been free of known melanomas or NCM when entered into the Registry. The cumulative 5-year life-table risks for developing melanoma and NCM were calculated. The relative risk for developing melanoma, using a control general population reference group, was determined.

Results. The 160 patients (median age at entry: 14 months) were followed prospectively for an average of 5.5 years. Three extracutaneous melanomas developed: 2 were in the central nervous system (CNS) and 1 was retroperitoneal. The 5-year cumulative life-table risk for developing melanoma was 2.3% (95% confidence interval [CI]: .8 – 6.6) and the relative risk was 101 (95% CI: 21– 296). No melanoma occurred within a large congenital melanocytic nevus. Four patients developed manifest NCM, 2 with CNS melanomas. The 5-year cumulative life-table risk for developing NCM was 2.5% (95% CI: .8 –7.2). Ten patients were excluded from the calculations because of preexisting disease on entry into the Registry: 5 with manifest NCM and 5 with melanomas (3 in large congenital melanocytic nevi, 1 in nonnevus skin, and 1 unknown primary).

Conclusions. Patients with large congenital cytic nevi are at increased risk for developing melano-mas. There is also a significant increased risk for devel-oping NCM. The high incidence of CNS involvement may influence decisions concerning treatment of the large congenital melanocytic nevi. Pediatrics 2000;106: 736 –741; large congenital melanocytic nevus, neurocuta-neous melanocytosis, malignant melanoma.

ABBREVIATIONS. NYU-LCMN Registry, Registry of Large Con-genital Melanocytic Nevi of the New York University School of Medicine; LCMN, large congenital melanocytic nevus/nevi; CNS, central nervous system; MRI, magnetic resonance imaging; NCM, neurocutaneous melanocytosis; SMR, standardized morbidity ra-tio; RR, relative risk; CI, confidence interval.

T

his report concerns the follow-up of patients who are in the Registry of Large Congenital Melanocytic Nevi of the New York University School of Medicine (NYU-LCMN Registry). The Reg-istry was created in 19791with the purpose of deter-mining the risk of melanoma in patients who have large congenital melanocytic nevi (LCMN). At that time, physicians worldwide were invited to partici-pate in the Registry by submitting patients in the database.

Results from this Registry were first published in 19882at which time data on 47 patients were suitable for analysis. The mean follow-up time of those pa-tients was 4.4 years. One patient had developed a primary central nervous system (CNS) melanoma during follow-up. In 1996, Marghoob et al3published an update of the NYU-LCMN Registry, at which time there were 92 patients, with an average fol-low-up of 5.4 years. Two more melanomas had de-veloped for a total of 3: 2 in the CNS and 1 in the retroperitoneum. No melanomas had developed within the LCMN themselves.

Currently, data on 194 patients with LCMN have been entered into the NYU-LCMN Registry, which accrued 3 additional years and 102 additional pa-tients since the last report in 1996.3

METHODS

Data on 194 patients with LCMN were entered into the NYU-LCMN Registry from March 1979 to January 1999. A NYU-LCMN was defined as a congenital melanocytic nevus that has, or is predicted to attain in adulthood, a largest diameter of at least 20 cm.1,4After entry into the Registry, attempts were made to follow the status of each patient.

Information concerning most patients was obtained from the physicians who initially provided the data for entering their pa-tients into the Registry. Most follow-up information was obtained by mail, telephone, and/or e-mail from physicians or the patients themselves. Some of the 194 patients were examined and followed at New York University Medical Center and in the private practice of one of the authors (A.W.K.).

The information recorded for each patient included: age at time of entry into the Registry; sex; location of the LCMN; number of melanocytic nevus satellites; any treatment of the LCMN; pres-ence of cutaneous or noncutaneous melanoma; and family history of melanoma. Since 1996, follow-up inquiries included questions specifically concerning CNS symptoms and/or signs and the re-sults of magnetic resonance imaging (MRI) scans. Photographs of the LCMN were available in most patient records.

Of the 194 patients who were entered into the NYU-LCMN Registry, 34 were excluded from the prospective analysis and calculations of risk for developing melanoma or neurocutaneous melanocytosis (NCM): 24 patients with⬍1 month of follow-up time, 5 patients who had developed melanomas before entry into the Registry, and 5 patients who had developed NCM before entry into the Registry.

From the *Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York; ‡Department of Dermatology, State University of New York at Stony Brook Health Sciences Center, Stony Brook, New York; and §Department of Environmental Med-icine, New York University School of MedMed-icine, New York, New York. Received for publication Jan 29, 1999; accepted Feb 7, 2000.

Reprint requests to (A.W.K.) Ronald O. Perelman Department of Derma-tology, New York University School of Medicine, 550 First Ave, New York, NY 10016. E-mail:akopf@compuserve.com

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The cumulative 5-year risk of developing melanoma was cal-culated, based on 160 patients, using the method of Kaplan and Meier,5and the exact binomial confidence limits were computed.6 Rates of melanoma from the white population of the Surveillance, Epidemiology, and End Results7 database were applied to the age/sex and length of follow-up distribution of our 160 patients to determine the number of melanomas that would have been ex-pected to occur in our patients had they experienced the same melanoma rates as the general population. The standardized mor-bidity ratio (SMR), which is the ratio of the observed to the expected number of melanomas and an estimation of the relative risk (RR), was calculated along with exact confidence limits.8The statistical significance of the SMR was determined by treating the observed number of melanomas as a Poisson variable.8The cu-mulative 5-year risk of developing NCM and the exact binomial confidence limits were also calculated.

RESULTS

The median age of the 160 prospectively followed patients with LCMN on entry into the study was 14 months (Table 1). Seventy-seven patients (48%) were entered into the Registry within the first year of life, and 120 (75%) within the first 5 years of life. There were 71 males and 89 females. One patient was black and all others were white. The average length of follow-up was 66.2 months (5.5 years).

One hundred thirty-two of the 160 patients (82%) had their LCMN in an axial distribution (trunk, head, and/or neck). Of these, 22 (14%) were located on the head/neck. The LCMN were limited to the extremi-ties in 28 patients (17%). Satellite nevi were present in 145 of the 160 patients (91%).

The treatments for the LCMN were complete ex-cision in 20 patients (12%) and partial removals in 73 patients (46%). Observation only was the approach in 66 (41%) and for 1 patient it was not known whether treatment had been undertaken. Of the 93 patients (58%) who had their LCMN treated, excision with direct closure was performed in 19 patients (20%), excision with graft in 20 (21%), tissue expand-ers followed by excision in 22 (24%), dermabrasion in 1, and⬎1 of the above types of surgical procedures in 16 (17%). Three patients had other types of surgi-cal procedures, such as cryotherapy. In 12 patients (13%) the precise type of treatment rendered was not known.

Since the last follow-up (1996) of the patients in the NYU-LCMN Registry, which reported that 3 patients developed melanoma, no additional patients have

developed melanomas within their LCMN or else-where. Thus, of the 160 prospectively followed pa-tients, 3 patients have developed melanomas on fol-low-up (2%): 2 melanomas in the CNS and 1 in the retroperitoneum (Tables 1 and 2). Note that the 2 patients (case 2 and 3) with CNS melanomas (Table 2) are also included as patients with NCM (Table 3). In addition, of the 34 patients excluded from the prospective data analysis, 5 had melanoma (Table 2). Of these 5 retrospectively diagnosed melanoma cases, 3 patients had developed melanomas within their LCMN (at 36 years, 52 years, and 1 month of age, respectively), 1 patient had melanoma with an unknown primary site (diagnosed at 3 years of age) and 1 had a melanoma arising in normal skin (at 57 years of age). These 5 patients with melanomas were not included in the calculations of risk, because their melanomas were diagnosed before entry into the Registry (Table 2).

In summary, 8 patients (4.1%) of the 194 in the NYU-LCMN Registry developed melanoma, of which 3 were diagnosed during prospective fol-low-up (Table 2). All 6 patients with the diagnosis of melanoma arising in noncutaneous sites or within the LCMN had their LCMN located on the back (posterior axis or paravetebral). The seventh mela-noma patient (case 7) had developed melamela-noma in normal skin (nonnevus-associated skin) and his LCMN was located on an extremity. For the eighth patient, the primary site was unknown. Each of the 8 patients with melanoma had⬎20 satellite nevi.

MRI scans were performed in 30 of the 160 pro-spectively followed patients (19%) in this analysis. The MRI was considered positive for NCM in 5 of these 30 patients (17%). Of these 5, 3 developed manifest NCM, ie, exhibited symptoms and/or signs of CNS involvement (Table 3; cases 2, 9, and 10). The 2 patients with MRI findings reported to be sugges-tive of NCM, but not exhibiting any clinical manifes-tations, have had follow-ups of 16 and 23 months, respectively (Table 4; cases 16 and 17). Because the results of MRI scans were not available for all pa-tients, it is not known what proportion of patients without manifestations of NCM might have positive MRI scans. Three patients with MRI findings sugges-tive of NCM but with no neurological signs and/or

TABLE 1. Study Population Statistics

No. of Patients Age in Months: Mean⫾SD at Entry in Study (Range; Median)

Sex, No. (%) Follow-Up in Months: Mean⫾SD (Range; Median)

Age in Months at Diagnosis of Melanoma or NCM:

Mean⫾SD (Range; Median)

Age in Months at Time of Death From Melanoma or NCM:

Mean⫾SD (Range; Median)

All (n⫽160) 76.6⫾141.6 M: 71 (44%) 66.2⫾64.1 NA NA

(1–756; 14) F: 89 (56%) (1–238; 42) Patients with

melanoma (n⫽3)*

3.6⫾2.0 (2–6; 3)

M: 1 (33.3%) F: 2 (66.6%)

12.0⫾6.5† (5–18; 13)

15.7⫾4.5 (11–20; 16)

19.3⫾5.7 (13–24; 21)

Patients with NCM (n⫽4)*

3.0⫾2.6 (1–12; 2)

M: 2 (50%) F: 2 (50%)

33.3⫾38.4‡ (5–77; 18)

36.3⫾29.7 (11–78; 25)

42.0⫾33.3 (13–87; 30)

NA indicates not applicable; SD, standard deviation.

* Two patients with CNS melanomas are included in both groups. † Months of follow-up to the diagnosis of melanoma.

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symptoms were excluded from the 160 used for cal-culations: 2 because there was no follow-up (Table 4; cases 18 and 19) and 1 because the patient had a melanoma before being entered into the Registry database (Tables 2 and 4; case 6). In total, 38 patients (30 patients as stated above, 3 patients on Table 4 who were excluded, and 5 patients on Table 3 with NCM diagnosed retrospectively) of 194 had an MRI scan performed. In 13 of the 38 patients (34%), the MRI scan was suggestive of NCM. Eight of the 13 patients with positive MRI scans developed manifest NCM, and 3 of these 8 symptomatic patients have died of NCM.

Another patient also developed manifest NCM (Table 3; case 3) but had not had an MRI performed, only a myelogram that showed tumors along the spinal cord.2Thus, of the 160 prospectively followed patients in the NYU-LCMN Registry, 4 have devel-oped NCM on follow-up (Table 3). All 4 patients with manifest NCM died: 2 from neurological

com-plications of NCM and 2 from melanomas in the CNS. The mean age of the 4 patients at the time of the diagnosis of NCM was 36 months, and the mean age at death was 42 months (Table 1). One of the 4 patients had Dandy-Walker syndrome. The associa-tion of NCM and Dandy-Walker syndrome is rare, with only 6 cases having been reported.9 –11The syn-drome represents an uncommon developmental anomaly characterized by aplasia or hypoplasia of the cerebellar vermis, with cystic dilatation of the fourth ventricle and enlargement of the posterior fossa.9In addition, of the 34 patients excluded from the prospective analysis, 5 patients had manifest NCM before they were entered into the NYU-LCMN Registry and were not included in the calculations of risk. Thus, 9 of the 194 patients (4.6%) of the NYU-LCMN Registry developed manifest NCM (Table 3). The LCMN were in posterior axial location in all 9 patients with manifest NCM (Table 3), and in the 5 patients with suggestive MRI findings of NCM but TABLE 2. Melanomas in NYU-LCMN Registry

Patient Case #

Age at Entry Into the Study

and (Sex)

Age at Diagnosis of Melanoma

Predominant Location of

the Nevus

Location of the Melanoma

Status

Melanomas diagnosed during follow-up

1 3 mo (F) 16 mo Back Retroperitoneum Dead of noncutaneous MM

at age 24 mo

2 6 mo (M) 11 mo Back CNS Dead of NCM and MM

mets at age 13 mo

3 2 mo (F) 20 mo Lumbosacral CNS Dead of NCM and MM

mets at age 21 mo Melanomas diagnosed before entry into registry*

4 36 y (F) 36 y Back Back (within the nevus)

(minimal deviation MM)42

Alive at age 40 y

5 52 y (M) 52 y Lumbosacral Groin (within the nevus) Dead of MM after 7 mo follow-up

6 12 mo (M) 1 mo Back Back (within the nevus

minimal deviation MM)42

Alive at age 69 mo

7 57 y (M) 57 y Right leg Left leg (in normal skin) Alive at age 63 y

8 36 mo (F) 36 mo Back Primary Unknown Dead of metastatic MM

after 3 mo follow-up

MM, indicates malignant melanoma; mets, metastasis. * Excluded from the life-table calculations.

TABLE 3. Manifest NCM in NYU-LCMN Registry

Patient Case #

Age at Entry Into the Study

and (Sex)

Age at Diagnosis of

NCM

Predominant Location of

the Nevus

CNS Symptoms MRI Status

Manifest NCM diagnosed during follow-up

9 1 mo (M) 78 mo Lumbosacral Dandy-Walker syndrome Positive Died of NCM at 87 mo

2* 6 mo (M) 11 mo Trunk Hydrocephalus

paraparesias

Positive Died of CNS MM at 13 mo

3* 2 mo (F) 20 mo Lumbosacral Decreased function of the right arm

None† Died of CNS MM and mets at 21 mo 10 12 mo (F) 36 mo Trunk Seizures, hydrocephalus Positive Died of NCM at 47 mo Manifest NCM diagnosed before entry into registry‡

11 1 mo (M) 1 mo Trunk Seizures, hydrocephalus Positive Alive at 8 y

12 5 mo (M) 1 mo Lower back Seizures Positive Alive at 13 mo

13 11 mo (F) 10 mo Bathing trunk Seizures Positive Alive at 26 mo

14 13 mo (M) 3 mo Bathing trunk Seizures Positive Alive at 20 mo

15 22 mo (M) 1 mo Bathing trunk Hydrocephalus Postive Alive at 6 y

MM indicates malignant melanoma.

* Patients 2 and 3 same as patients in Table 2 (melanomas diagnosed during follow-up). † A myelogram was performed (positive for tumor on spinal cord).

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without neurological manifestations (Table 4). Satel-lites were present in all these 14 patients.

The 5-year cumulative risk of developing mela-noma (Fig 1) for the 160 prospectively followed pa-tients was 2.3% (95% confidence interval [CI]: .8 – 6.6). The expected number of melanomas in our study group based on the Surveillance, Epidemiol-ogy, and End Results program rates was .029, and the SMR (RR) was calculated to be 101 (95% CI: 21–296;P⬍.0001).

The 5-year cumulative risk of developing NCM (Fig 1) for the 160 followed patients was 2.5% (95% CI: 0.8 –7.2). The risk of developing melanoma and/or NCM (Fig 1) was 3.3% (95% CI: 1.3– 8.2).

The number who developed melanoma and/or NCM of all 194 patients, including those who had melanomas and/or NCM before entry into the Reg-istry, in various categories of largest diameter of the LCMN is shown in Fig 2. Of the 15 patients who

developed melanomas and/or NCM (6, melanomas only; 7, NCM only; and 2, both melanoma and NCM), 14 had LCMN 50 cm or larger in diameter.

DISCUSSION

The increased risk for developing melanomas in patients with LCMN is well-established.1– 4,12–22The reported lifetime risk ranges from 4.5% to 8.5% in various studies.12–16

No additional melanomas have developed in pa-tients in the NYU-LCMN Registry since the last re-port3in 1996; thus, melanomas occurred in 3 of the 160 prospectively followed patients: 2 in the CNS and 1 in the retroperitoneum. So far no melanomas developed within the LCMN in our prospective fol-low-up. The life-table analysis yielded a cumulative 5-year risk for development of melanoma of 2.3% (95% CI: .8 – 6.6). It is possible that the surgical treat-ments of the LCMN in 93 of our 160 patients (58%) were in part responsible for the relatively low occur-rence of melanomas within the nevi in our series. The median age of the 160 patients at entry into our study was 14 months, and the average follow-up time was 5.5 years. Because 70% of the melanomas reported in patients with LCMN are diagnosed before puberty,3 many of our patients were followed during those years of life in which such patients are at greatest risk for developing melanomas.

The average follow-up (5.5 years) was 1 month longer than that in the last report,3 although the Registry has accrued 3 additional years of new cases to a total of 883 patient-years of follow-up. The rea-son for the small increase in average follow-up is that the large number of patients68entered into the Reg-istry in the last 3 years have had short follow-ups, thus reducing the average.

In addition to the risk of developing melanoma, attention has recently focused on the development of NCM in patients with LCMN.22–29NCM is rare, with

⬃100 cases reported in the world literature.30 NCM is characterized by the presence of benign and/or malignant melanocytic proliferations in the CNS in association with a LCMN or 3 or more smaller con-genital melanocytic nevi.28 The majority of cases of

TABLE 4. Patients in the NYU-LCMN Registry With MRI Findings Suggestive of NCM But Without Neurologic Signs and/or Symptoms*

Patient Case #

Age at Entry into the Study

and (Sex)

Predominant Location of

the Nevus

Age When the

MRI was Performed

MRI Clinical Status

16 1 mo (M) Upper back 1 mo “Multiple foci of increased T1 signal”

No neurological signs and/ or symptoms at 24 mo of follow-up

17 3 mo (M) Upper back 1 mo “High signal on T1

imaging in the uncus of the right temporal lobe”

No neurological signs and/ or symptoms at 19 mo of follow-up

6† 12 mo (M) Back 7 mo “Suggestive” No neurological signs and/

or symptoms at 69 mo of follow-up

18‡ 1 mo (F) Back 1 mo “Multiple foci of increased

T1 signal”

No follow-up

19‡ 26 mo (M) Lumbosacral Unknown “Diffuse T1 shortening” No follow-up

* All the cases had the MRI performed before entry into the Registry.

† Case excluded from all calculations because had a melanoma before entry into the Registry. ‡ Cases excluded from all calculations because lack of follow-up.

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manifest NCM occur early in life, usually before the age of 3 years, although there are several reports of manifest NCM starting in adulthood.27,31–34The clin-ical findings are mostly attributable to increased ce-rebrospinal fluid pressure and hydrocephalus as a result of blockage of the cisternal pathways and obliteration of arachnoid villi by the proliferating melanocytes.28,35 The prognosis of manifest NCM is poor, with⬎90% dying secondary to benign and/or malignant CNS melanocytosis.28The majority of the patients die within 3 years of their initial neurologi-cal symptoms,28 ⬃70% dying before the age of 10 years.28 Approximately 40% to 50% of the patients with manifest NCM develop primary CNS melano-mas.36

The risk for patients with LCMN of developing manifest NCM is not known but patients with such nevi located on the head, posterior neck, and/or paravertebral area seem to have the highest risk.24,26,28 DeDavid et al24 reviewed 289 cases of LCMN and found that 33 (12%) had developed man-ifest NCM. CNS melanomas occurred in 21 of the 33 patients (64%) with manifest NCM. Furthermore, all 33 patients with NCM had their large nevi in axial locations (cephalic, posterior cervical, and paraverte-bral), and of the 31 patients for whom the presence or absence of satellites was known, all had satellite nevi. An additional risk factor may be the diameter of the LCMN. As shown in Fig 2, 118 LCMN of the 194 (61%) had diameters of 50 cm or greater. Strikingly, 14 of the 15 patients (93%) who developed melanoma and/or NCM fell in this category. All 14 of these patients had LCMN in posterior axial locations (paravetebral) and had multiple satellite nevi. Only 1 melanoma occurred in the remaining 76 of 194 pa-tients (39%) who had LCMN ⬍50 cm in diameter. This 1 patient differed from the other 14 in that his melanoma developed on normal skin as opposed to within the LCMN or extracutaneous sites.

In our series of 160 patients, 4 developed manifest NCM. The life-table analysis yielded a cumulative 5-year risk for NCM of 2.5% (95% CI: .8 –7.2). All 4 patients with manifest NCM died: 2 of CNS melano-mas and 2 of benign neural melanocytosis.

It seems that, in our series, the risk for

develop-ment of fatal NCM (with or without CNS melanoma) is higher than for development of fatal non-CNS melanoma (Tables 2 and 3).

In our Registry, the LCMN were at least in part in paravertebral location in all 9 patients with manifest NCM and in the 5 with nonmanifest NCM (Tables 3 and 4). Satellites were present in all 14 patients.

The presence of manifest NCM is extremely im-portant in the management of a patient with a LCMN because of its generally poor prognosis. The goal of removing all the melanocytic tissue with extensive surgical procedures would be unachievable when the melanocytic proliferation also involves the CNS. In addition, it has been suggested that in patients with manifest NCM the risk of developing mela-noma is higher in the CNS than in the skin.11,28MRI with contrast is the best diagnostic imaging modality for diagnosing NCM.37,38T1-weighted shortening in an MRI scan suggests the presence of melanin in the CNS.37,38However, other substances in the CNS are also known to cause T1-weighted shortening, includ-ing fat and subacute hemorrhage.30

With the advent of MRI scans, it has been possible to identify more patients who have nonmanifest NCM.25That such patients exist was previously sug-gested by the incidental finding of NCM in autopsies of asymptomatic patients with LCMN who died of unrelated causes.39,40 We now recommend MRI scans for all patients with LCMN, especially those judged to be at greatest risk for the development of NCM (ie, with paravertebral, posterior cervical and/or cephalic involvement). Because of the more frequent use of MRI scans, more patients with puta-tive nonmanifest NCM are being identified. Two patients in our prospective series of 160 (5 patients in our entire series of 194; Table 4) who had MRI scans performed had MRI findings suggestive of NCM but without any neurologic manifestations. The preva-lence of nonmanifest NCM in persons with LCMN is not known.25Frieden et al25found brain abnormali-ties on MRI scans of the cerebrum in 45% of the asymptomatic patients with LCMN. Although it is not known what percentage of asymptomatic pa-tients with MRI findings suggestive of NCM will develop manifest neurological disease, these authors Fig 2. Occurrence of melanoma and/or NCM by

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believe that is unlikely that all infants with sugges-tive evidence of melanocytosis on MRI scans will develop symptomatic neurologic disease.

It is important to clarify this issue to help deter-mine which patients would benefit most from the surgical removal of their LCMN. Because most of the patients with manifest NCM have had neurological symptoms or signs within the first 3 years of life,28 perhaps surgical intervention for LCMN should be postponed until age 3 years for asymptomatic pa-tients with MRI findings suggestive of NCM.24 The decision to postpone surgery is made very difficult by the fact that many of the cutaneous melanomas reported to have arisen in association with LCMN also occurred by 3 years of age.24

CONCLUSION

Patients with LCMN are at increased risk for de-veloping cutaneous melanoma, extracutaneous mel-anoma, and NCM. It seems that individuals at great-est risk are those with very large LCMN (ⱖ50 cm), LCMN in axial locations, and those with multiple satellite nevi.

ACKNOWLEDGMENTS

This work was supported by the Ronald O. Perelman Depart-ment of Dermatology, NYU School of Medicine; the Joseph H. Hazen Foundation; the Niarchos Fund of the Skin Cancer Foun-dation; the Mary and Emanuel Rosenfeld FounFoun-dation; and the Kaplan Comprehensive Cancer Center (Cancer Center Support Core Grant 5P30-16087-18).

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2000;106;736

Pediatrics

Robert S. Bart

Flavia V. Bittencourt, Ashfaq A. Marghoob, Alfred W. Kopf, Karen L. Koenig and

Melanoma and Neurocutaneous Melanocytosis

Large Congenital Melanocytic Nevi and the Risk for Development of Malignant

Services

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(8)

2000;106;736

Pediatrics

Robert S. Bart

Flavia V. Bittencourt, Ashfaq A. Marghoob, Alfred W. Kopf, Karen L. Koenig and

Melanoma and Neurocutaneous Melanocytosis

Large Congenital Melanocytic Nevi and the Risk for Development of Malignant

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by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

Figure

TABLE 1.Study Population Statistics
TABLE 3.Manifest NCM in NYU-LCMN Registry
TABLE 4.Symptoms*
Fig 2. Occurrence of melanoma and/or NCM by di-ameter of the LCMN. Occurrence of melanomaand/or NCM by largest diameter of the 194 LCMN inthe NYU-LCMN Registry

References

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