Use of sentinel lymph node biopsy for melanoma in children and adolescents

Abstract

SLNB use for children with melanoma was associated with clinicopathologic, socioeconomic, and hospital factors. Younger patients have a higher likelihood of LNM but are the least likely to undergo SLNB. Though overall adherence appears high, there remains an opportunity for improved care for children with melanoma.

Sentinel Node Biopsy in Pediatric Patients: The Experience in a Single Institution

“…In children affected by melanoma, the overall use of SLNB has not been well documented, and from the data of literature, this procedure is done in 70% of children. 24 LNs metastases, however, are more prevalent in children as compared with adults, 10,25 and the American Joint Committee on Cancer (AJCC) staging manual recommends SLNB in case of localized primary cutaneous melanoma > 1 mm thick (T2) or with tumors < 1-mm thick in the presence of Clark level IV invasion, ulceration, or high mitotic rate (T1b). 26 In the series of children with melanoma described by Howman-Giles et al the positivity rate was higher than in adults, 10 and from the 2008 Surveillance, Epidemiology and End Results, 27 thickness and ulceration were strong predictors of both the use of SLNB and positive SLNB results in children and young adults.…”

“…28 Still, the use seems dependent from clinicopathologic, socioeconomic, and hospital factors, being the patients who more likely undergo SLNB those who are older, have insurance or are cared for at COG hospital. 24 This is probably not applicable in the European context, but it still seems necessary to provide guidance in the future management of these children. Our own experience as a single institution is very poor.…”

Spitz Nevi

“…19,34,41 A 30% to 40% likelihood of SLNB positivity has also been documented in several series of pediatric melanomas, similar to that seen with ASNs. 19,[41][42][43][44][45] Although prepubertal children with melanoma diagnoses tend to have thicker tumors (which are often spitzoid) and a higher rate of positive SLNB results than adolescents or adults, survival in many series is paradoxically longer in prepubertal patients (overall mean 5-year survival, approximately 90% vs approximately 50% in adolescents). 19,[42][43][44][45][46][47] Because it can be difficult to determine whether some ASNs represent Spitz nevi (with benign behavior) or spitzoid melanomas (with malignant behavior) based on their histologic features, series of "pediatric melanomas" undoubtedly include both types of lesions.…”

The Application and Indications for Sentinel Lymph Node Biopsy in Pediatric Solid Tumors: Current Status and Future Directions

“…However, others have been unable to demonstrate a significant association between a positive SLNB and overall survival [65]. Despite higher rates of positive SLNB, children and adolescents have a lower incidence of recurrence and improved disease-free survival when compared to adults [45] [62].…”