The Unique Clinical Characteristics of Melanoma Diagnosed in Children

Abstract

Background Studies have demonstrated a higher rate of nodal metastases in melanoma of childhood, but there is controversy about the overall prognosis relative to adults. We describe a large single-institution experience with pediatric melanoma and assess prognostic characteristics. Methods Retrospective review identified 126 patients diagnosed with melanoma at <21 years of age and referred for treatment from 1986 to 2011. Atypical lesions were excluded. Clinicopathologic characteristics were correlated with sentinel lymph node (SLN) status and outcomes. Results SLN biopsy was positive in 18 of 62 cases (29 %). Increasing Breslow thickness correlated with a positive SLN (p < 0.05). After a median follow-up of 5 years, there were 27 recurrences and 20 deaths. Positive SLN patients had significantly worse recurrence-free survival (RFS, p < 0.05) and significantly worse melanomaspecific survival (MSS, p = 0.05) compared with negative SLN patients. The 5-year RFS and MSS for positive SLN patients were 59.5 and 77.8 %, compared with 93.7 and 96.8 % for negative SLN patients. Recurrences and melanoma-related deaths were often seen beyond 5 years. No deaths have occurred in patients <12 years, but 9.1 % of patients 12–17 years and 17.2 % of patients 18–20 years died from melanoma (p = 0.291). Conclusions Children with melanoma have higher rates of SLN metastases (29 %) than adults with comparable melanomas. Despite the higher incidence of nodal metastases, survival is equal to or better than what is reported for adults. However, long-term follow-up is necessary in this population since recurrences and deaths are often seen beyond 5 years.

Spitzoid tumors in children and adults

“…Despite the limited number of patients in this preliminary study, the following conclusions can be drawn: (i) in some SNi, as in the cases of ASNi, the follow-up remains the most important factor to determine the clinical behavior; (ii) FISH seems reliable in most of the lesions found in adults, although not superior to conventional histology; (iii) FISH assay in pediatric patients with SNi should be interpreted carefully in the context of the histological features as melanomas in the pediatric population show distinct chromosomal aberrations [21,22].…”

Radicalization of surgical treatment in pediatric melanoma malignum

“…Previous studies have reported that compared with adults, pediatric melanoma patients exhibit higher rates of lymph node metastases ranging from 25 to 40% [10]. Although higher rates of lymph node metastases have been reported in pediatric melanoma patients, the prognostic value of sentinel lymph node biopsy (SLNB) has not been extensively studied in this population.…”

“…Although higher rates of lymph node metastases have been reported in pediatric melanoma patients, the prognostic value of sentinel lymph node biopsy (SLNB) has not been extensively studied in this population. The few studies on SLNB for pediatric melanoma have reported varying results, with some studies reporting no recurrences or deaths in positive SLNB patients while one study showed that the overall survival rate of 94% seen in pediatric melanoma patients dropped to 79 % in positive SLNB patients [10,11]. Currently, there is a common agreement that pediatric patients with clinically localized melanomas >1 mm thickness should be offered SLNB.…”

Controversies in the Evaluation and Management of Atypical Melanocytic Proliferations in Children, Adolescents, and Young Adults

“…48,49 The rate of sentinel node involvement in pediatric melanoma is well established to be higher than that in adult melanoma, roughly 25% to 40%. 50–52 Data regarding sentinel node status in AMPs are difficult to interpret, because most reports are retrospective reviews and likely have recategorized some AMPs with obvious malignancy in the nodes as melanoma.…”