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Abele M, Forchhammer S, Eigentler TK, Popescu A, Maschke L, Lohse J, Lehrnbecher T, Behnisch W, Groll AH, Jakob M, Bernbeck B, Brecht IB, Schneider DT. Melanoma of the central nervous system based on neurocutaneous melanocytosis in childhood: A rare but fatal condition. Pediatr Blood Cancer 2024; 71:e30859. [PMID: 38225622 DOI: 10.1002/pbc.30859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/05/2023] [Accepted: 12/24/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Melanomas of the central nervous system (CNS) based on neurocutaneous melanocytosis (NCM) are exceptionally rare in childhood and have been described only sporadically. Rapidly progressive disease may represent a major challenge for treating physicians, especially given the limited knowledge about this condition. This analysis aimed to increase knowledge about the occurrence and treatment of these malignancies. PROCEDURE Data on diagnosis, treatment, and outcome of patients aged 0-18 years with CNS melanoma based on NCM recorded in the German Registry for Rare Pediatric Tumors (STEP registry) were analyzed. Additionally, published case reports on this condition were analyzed. RESULTS In STEP, five patients with leptomeningeal melanoma based on NCM were identified, with a median age at melanoma diagnosis of 3.7 years. Various multimodal treatments were performed: (partial) resection (n = 4), irradiation (n = 2), trametinib (n = 3), different cytostatics (n = 2), and anti-GD2 immunotherapy (n = 1). All patients died between 0.3 and 0.8 years after diagnosis. Including published case reports, 27 patients were identified with a median age of 2.8 years at melanoma diagnosis (range: 0.2-16.6). Fourteen of 16 cases with reported data had a NRAS alteration (88%), particularly NRAS p.Q61K (85%). In the expanded cohort, no patient survived longer than 1 year after diagnosis despite multimodal therapy (including trametinib; n = 9), with a median survival of 0.4 years (range 0.1-0.9). CONCLUSIONS CNS melanomas based on NCM in childhood are aggressive malignancies without curative treatment to date. Therapeutic approaches must be individualized. Genetic tumor sequencing is essential to improve understanding of tumorigenesis and potentially identify new therapeutic targets.
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Affiliation(s)
- Michael Abele
- Department of Pediatrics, Pediatric Hematology/Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Forchhammer
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, Tübingen, Germany
| | - Thomas K Eigentler
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Aryana Popescu
- Department of Pediatrics, Pediatric Hematology/Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Linda Maschke
- Department of Pediatrics, Pediatric Hematology/Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Judith Lohse
- Department of Pediatrics, Pediatric Hematology and Oncology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Thomas Lehrnbecher
- Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University, Frankfurt, Germany
| | - Wolfgang Behnisch
- Department of Pediatric Oncology, Hematology and Immunology, University of Heidelberg, Heidelberg, Germany
| | - Andreas H Groll
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Marcus Jakob
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital of Regensburg, Regensburg, Germany
| | - Benedikt Bernbeck
- Clinic of Pediatrics, Klinikum Dortmund, University Witten/Herdecke, Dortmund, Germany
| | - Ines B Brecht
- Department of Pediatrics, Pediatric Hematology/Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Dominik T Schneider
- Clinic of Pediatrics, Klinikum Dortmund, University Witten/Herdecke, Dortmund, Germany
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