Abstract: A malignant melanoma originally diagnosed as a Spitz nevus led to the death of a 10-year-old boy. The melanoma developed four years after therapy was begun for acute lymphoblastic leukemia. Melanomas in children are rare. Melanomas histologically resembling Spitz ncvi have been reported. Deep contiguous growth and melanization are suspicious features. Lymphoproliferative malignancies are most commonly reported to occur in patients surviving treatment for acute lymphoblastic leukemia. Melanoma following acute lymphoblastic leukemia has not been described previously.