Malignant melanoma. Less than 2 percent of all melanomas occur during childhood. Nonetheless, attention must be paid to signs and symptoms suggestive of this potentially fatal disease. Variegations of color are of particular concern. Irregular or notched borders, bleeding, and ulceration are other signs of malignant change. The patient may give a history of itching, and the parents may have noted rapid growth of the lesion. Because the prognosis of a melanoma is most closely related to the thickness of the lesion at the time of treatment, emphasis should be on early diagnosis.