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Conclusions While the prevalence of melanoma in the pediatric population is exceedingly low, a high index of suspicion should be maintained for any rapidly growing or otherwise changing pigmented skin lesion, and excisional biopsy should be pursued for complete histopathologic evaluation
However, circulating TMAO levels are dynamically variable and are tightly regulated by diet, gut microbiome composition, liver enzyme activity, and renal excretion
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For patients whose levels fall in the borderline or gray zone, a methylmalonic acid (MMA) test provides greater specificity MMA levels rise when B12 is functionally inadequate at the cellular level, even if serum B12 appears borderline normal
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