Pediatric Skin Cancer: Melanoma, Basal and Squamous Cell Carcinomas, and Dermatofibrosarcoma Protuberans

Pediatric cutaneous malignancies are rare but form distinct clinical and molecular biological subgroups from adult skin cancers. This review focuses on major diseases of childhood and adolescence-malignant melanoma, basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and dermatofibrosarcoma protuberans (DFSP)-outlining their epidemiology, clinical features, molecular drivers, and treatment strategies. Pediatric malignant melanoma is primarily classified into adult-like tumors with BRAF/NRAS mutations, Spitz melanoma arising from kinase fusion genes, and congenital nevi with NRAS mutations. Spitz tumors form a clinically challenging diagnostic spectrum, but advances in molecular profiling have enabled subclassification and risk stratification. Pediatric BCC typically arises from syndromic or iatrogenic factors, whereas pediatric SCC is strongly associated with DNA-repair defects, immunosuppression, and chronic inflammation; both require long-term follow-up. Although rare, DFSP is the most frequent cutaneous sarcoma in pediatric patients and typically exhibits COL1A1-PDGFB fusions. Considering the pediatric-specific factors common to these malignancies, individualized treatment approaches are required. This review integrates the latest findings in molecular pathology and clinical guidelines to support accurate diagnosis, treatment, and follow-up in pediatric dermatology.