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Hatheway Marshall E, Alvarez G, Wang B, Crimmins J, Schneider MM, Selim MA, Al-Rohil RN. Pediatric Atypical Melanocytic Proliferations: Single-Site Retrospective Cohort Assessment of Treatment and Long-Term Follow-Up. Cancers (Basel) 2023; 15:5804. [PMID: 38136349 PMCID: PMC10741983 DOI: 10.3390/cancers15245804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/06/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
Atypical and malignant cutaneous tumors are understudied in the pediatric population, with limited data on long-term follow-up. This study examines pediatric (0-18 years) atypical melanocytic proliferations over a twenty-year period (January 2002-December2022) using the EPIC SlicerDicer at our institution. Over a twenty-year period, there were 55 cases of pediatric melanoma (53 patients). The median follow-up time was 8 years, 11 months. A proportion of 96% were treated with wide local excision (WLE), and 47% had a sentinel lymph node biopsy (SLNB) (35% positive rate). There were 101 atypical Spitz tumor cases (85% atypical Spitz tumors, 15% Spitz melanoma), with a median follow-up duration of 9 years. A proportion of 77% were treated with WLE (with one patient dying of metastatic disease). There were 10 cases of atypical melanocytic proliferations not otherwise specified, including 5 pigmented epithelioid melanocytomas (PEM), 4 deep-penetrating nevi, and 1 atypical cellular blue nevus. This study adds to the growing body of knowledge on pediatric atypical cutaneous melanocytic proliferations, aligning with many described characteristics such as disease location and overall survival rates, with distinct exceptions (higher melanoma positive SLNB rate, lower atypical Spitz tumor WLE rate, and a case of fatal metastatic atypical Spitz tumor).
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Affiliation(s)
| | - Gabriella Alvarez
- Department of Internal Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA;
| | - Bangchen Wang
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA; (B.W.); (J.C.); (M.A.S.)
| | - Jennifer Crimmins
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA; (B.W.); (J.C.); (M.A.S.)
| | - Michelle M. Schneider
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA; (B.W.); (J.C.); (M.A.S.)
| | - M. Angelica Selim
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA; (B.W.); (J.C.); (M.A.S.)
| | - Rami N. Al-Rohil
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA; (B.W.); (J.C.); (M.A.S.)
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2
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Pampena R, Piccolo V, Muscianese M, Kyrgidis A, Lai M, Russo T, Briatico G, Di Brizzi EV, Cascone G, Pellerone S, Longo C, Moscarella E, Argenziano G. Melanoma in children: A systematic review and individual patient meta-analysis. J Eur Acad Dermatol Venereol 2023; 37:1758-1776. [PMID: 37210654 DOI: 10.1111/jdv.19220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/07/2023] [Indexed: 05/22/2023]
Abstract
The current evidence on paediatric melanoma is heterogeneous, especially regarding the prognosis of different histological subtypes. We sought to systematically review the evidence on paediatric melanoma, highlighting the major sources of heterogeneity and focusing on available data on single patients. A systematic search was performed from 1948 to 25 January 2021. Only studies reporting at least one case of cutaneous melanoma in patients aged ≤18 years were included. Unknown primary and uncertain malignant melanomas were excluded. Three couples of authors independently performed title/abstract screening and two different authors reviewed all the relevant full texts. The selected articles were manually cross-checked for overlapping data for qualitative synthesis. Subsequently data on single patients were extracted to perform a patient-level meta-analysis. PROSPERO registration number: CRD42021233248. The main outcomes were melanoma-specific survival (MSS) and progression-free survival (PFS) outcomes. Separate analyses were done of cases with complete information on histologic subtype, focusing on superficial spreading (SSM), nodular (NM) and spitzoid melanomas, as well as of those classified as de-novo (DNM) and acquired or congenital nevus-associated melanomas (NAM). The qualitative synthesis covered 266 studies; however, data on single patients were available from 213 studies including 1002 patients. Among histologic subtypes, NM had a lower MSS than both SSM and spitzoid melanoma, and a lower PFS than SSM. Spitzoid melanoma had a significantly higher progression risk than SSM and trended toward lower mortality. Focusing on nevus-associated status, DNM demonstrated better MSS after progression than congenital NAM, and no differences were highlighted in PFS. Our findings describe the existence of different biological patterns in paediatric melanoma. Specifically, spitzoid melanomas demonstrated intermediate behaviour between SSM and NM and showed a high risk of nodal progression but low mortality. This raises the question of whether spitzoid lesions are being over-diagnosed as melanoma in childhood.
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Affiliation(s)
- Riccardo Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Athanassios Kyrgidis
- Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michela Lai
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Teresa Russo
- Dermatology Unit, University of Campania, Naples, Italy
| | | | | | | | | | - Caterina Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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3
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Fortes C, Mastroeni S, Capuano M, Ricozzi I, Bono R, Ricci F, Pagnanelli G, Nudo M. Differences in individual and environmental factors between cutaneous melanoma and atypical Spitz tumour in children and adolescents. Eur J Pediatr 2022; 181:263-269. [PMID: 34275015 DOI: 10.1007/s00431-021-04204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/27/2022]
Abstract
It is not known if children and adolescents with atypical Spitz tumour and cutaneous melanoma differ in terms of etiological factors. The aim of this study was to explain differences in individual and environmental factors between cutaneous melanoma and atypical Spitz tumour. In the context of a study on melanocytic lesions, all subjects aged under 20 years with either cutaneous melanoma or atypical Spitz tumour were included (N = 105). Information on socio-demographic characteristics, individual and environmental factors were collected for both mother and child. The Fisher's exact test and the Mann-Whitney U test were used for categorical variables and continuous variables respectively. A multivariate logistic model was used to explain differences in outcome by differences in explanatory variables. In comparison to patients with cutaneous melanoma, patients with atypical Spitz tumour had less freckles (p = 0.020), lower number of common nevi (p = 0.002), and lower body mass index (p = 0.001) and experienced less sunburns episodes (p = 0.008). However, in the multivariate analysis, only a low number of common nevi remained statistically significant. Children and adolescents with cutaneous melanoma have a high number of nevi in comparison to the same-age group with atypical Spitz tumour.Conclusion: The results of this study suggest that the only difference in individual and environmental risk factors between cutaneous melanoma and atypical Spitz tumour in children and adolescents is the number of nevi. What is Known: •Atypical Spitz tumours and cutaneous melanoma in children and adolescents are clinically similar, but compared with melanoma, they have a good overall prognosis. •Risk factors for cutaneous melanoma in children and adolescents are similar to the ones found in adults in the literature What is New: •Differences in individual and environmental risk factors for atypical Spitz tumour in children and adolescents are described for the first time in this study. •Individual and environmental factors for atypical Spitz tumour in children and adolescents are comparable to cutaneous melanoma, except for the presence of low number of nevi.
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Affiliation(s)
- Cristina Fortes
- Istituto Dermopatico Dell'Immacolata Concezione, IDI-IRCCS, Rome, Italy.
| | - Simona Mastroeni
- Istituto Dermopatico Dell'Immacolata Concezione, IDI-IRCCS, Rome, Italy
| | - Maria Capuano
- Istituto Dermopatico Dell'Immacolata Concezione, IDI-IRCCS, Capranica, Viterbo, Italy
| | - Ilaria Ricozzi
- Istituto Dermopatico Dell'Immacolata Concezione, IDI-IRCCS, Rome, Italy
| | - Riccardo Bono
- Istituto Dermopatico Dell'Immacolata Concezione, IDI-IRCCS, Rome, Italy
| | - Francesco Ricci
- Istituto Dermopatico Dell'Immacolata Concezione, IDI-IRCCS, Rome, Italy
| | | | - Maurizio Nudo
- Dermatology Department, Humanitas Castelli, Bergamo, Italy
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4
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Del Fiore P, Russo I, Ferrazzi B, Monico AD, Cavallin F, Filoni A, Tropea S, Russano F, Di Prata C, Buja A, Collodetto A, Spina R, Carraro S, Cappellesso R, Nicolè L, Chiarion-Sileni V, Pigozzo J, Dall'Olmo L, Rastrelli M, Vecchiato A, Benna C, Menin C, Di Carlo D, Bisogno G, Dei Tos AP, Alaibac M, Mocellin S. Melanoma in Adolescents and Young Adults: Evaluation of the Characteristics, Treatment Strategies, and Prognostic Factors in a Monocentric Retrospective Study. Front Oncol 2021; 11:725523. [PMID: 34604064 PMCID: PMC8482997 DOI: 10.3389/fonc.2021.725523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/01/2021] [Indexed: 12/09/2022] Open
Abstract
The "Veneto Cancer Registry" records melanoma as the most common cancer diagnosed in males and the third common cancer in females under 50 years of age in the Veneto Region (Italy). While melanoma is rare in children, it has greater incidence in adolescents and young adults (AYA), but literature offers only few studies specifically focused on AYA melanoma. The aim of this study was to describe the characteristics, surgical treatment, and prognosis of a cohort of AYA melanoma in order to contribute to the investigation of this malignancy and provide better patient care. This retrospective cohort study included 2,752 Caucasian patients (702 AYA and 2,050 non-AYA patients) from the Veneto Region who were over 15 years of age at diagnosis, and who received diagnosis and/or treatment from our institutions between 1998 and 2014. Patients were divided in adolescents and youth (15-25 years), young adults (26-39 years) and adults (more than 39 years) for the analysis. We found statistically significant differences in gender, primary site, Breslow thickness, ulceration, pathologic TNM classification (pTNM) stage and tumor subtype among the age groups. Disease-specific survival and disease-free survival were also different among the age groups. Our findings suggest that the biological behavior of melanoma in young people is different to that in adults, but not such as to represent a distinct pathological entity. Additional and larger prospective studies should be performed to better evaluate potential biological and cancer-specific differences between AYAs and the adult melanoma population.
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Affiliation(s)
- Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV- IRCCS, Padua, Italy
| | - Irene Russo
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV- IRCCS, Padua, Italy.,Division of Dermatology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Beatrice Ferrazzi
- Postgraduate School of Occupational Medicine, University of Verona, Verona, Italy
| | - Alessandro Dal Monico
- Department of Medicine, University of Padua School of Medicine and Surgery, Padua, Italy
| | | | - Angela Filoni
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV- IRCCS, Padua, Italy
| | - Saveria Tropea
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV- IRCCS, Padua, Italy
| | - Francesco Russano
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV- IRCCS, Padua, Italy
| | - Claudia Di Prata
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV- IRCCS, Padua, Italy
| | - Alessandra Buja
- Department of Cardiological, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alessandra Collodetto
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV- IRCCS, Padua, Italy
| | - Romina Spina
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV- IRCCS, Padua, Italy
| | - Sabrina Carraro
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV- IRCCS, Padua, Italy
| | - Rocco Cappellesso
- Pathological Anatomy Unit, University Hospital of Padua, Padua, Italy
| | - Lorenzo Nicolè
- Department of Medicine (DIMED), Unit of Pathology & Cytopathology, University of Padua, Padua, Italy.,Unit of Surgical Pathology & Cytopathology, Ospedale dell'Angelo, Mestre, Italy
| | | | - Jacopo Pigozzo
- Melanoma Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Luigi Dall'Olmo
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV- IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Marco Rastrelli
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV- IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Antonella Vecchiato
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Clara Benna
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Chiara Menin
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Daniela Di Carlo
- Hematology/Oncology Division, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Gianni Bisogno
- Hematology/Oncology Division, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | | | - Mauro Alaibac
- Division of Dermatology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV- IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
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5
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Yousif R, Boull C, Gerami P, Nardone B, Vivar KL, Liszewski W. THE demographics and trends in pediatric melanoma in the United States: An analysis of the National Cancer Database. Pediatr Dermatol 2021; 38:1191-1197. [PMID: 34250622 DOI: 10.1111/pde.14672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/04/2021] [Accepted: 05/23/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVE Relative to adults, rates of melanoma are lower in children. Due to its rarity, it is difficult to assess the incidence, trends, and outcomes of this malignancy. Much of our understanding comes from single institution or regional cancer registries which may not be large enough to detect subtleties in the burden of pediatric melanoma. METHODS Data from the 2004 to 2016 National Cancer Database were analyzed; this database captures approximately 70% of all cancer diagnoses in the United States. RESULTS Our analysis consisted of 1903 cases. A majority were White (89.8%), the mean age was 12.4 years, and the ratio of females: males was 1.2:1.0. The most common anatomic location was the trunk (31.1%). Between 2004 and 2016, a decreasing trend in the number of new melanoma cases was observed. Comparing histologic subtype by age, there was an increased percentage of nodular and epithelioid and spindle cell tumors in the pre-teen children and a greater percentage of superficial spreading tumors in teenagers. Overall, a majority of cases were stage 0 or I (56.9%), with relatively few stage IV cases (2.0%). A 5-year all-cause survival of greater than 90% was observed for stage I-III tumors, with stage IV tumors having a 5-year all-cause survival of 34.4%. CONCLUSION Comparable to previous studies, pediatric melanoma occurred most often in Whites, females, and adolescents. However, we detected a decreasing trend in new cases, noted differences between histologic subtype and age, and observed a 5-year all-cause survival rate of greater than 90% for stage I-III tumors.
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Affiliation(s)
- Rame Yousif
- University of Toledo College of Medicine, Toledo, OH, USA
| | - Christina Boull
- Department of Dermatology, Division of Pediatric Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - Pedram Gerami
- Department of Dermatology, Northwestern University, Chicago, IL, USA.,Division of Dermatopathology, Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - Beatrice Nardone
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - Karina L Vivar
- Department of Dermatology, Northwestern University, Chicago, IL, USA.,Division of Pediatric Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Walter Liszewski
- Department of Dermatology, Northwestern University, Chicago, IL, USA.,Division of Cancer Epidemiology and Prevention, Department of Preventative Medicine, Northwestern University, Chicago, IL, USA
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6
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Abstract
Age plays a dynamic role in incidence, presentation, and extent of disease for cutaneous melanoma. Even within the spectrum of juvenile melanoma, there exists a range of spitzoid and nonspitzoid melanocytic and melanoma lesions. Spitzoid melanomas, a more favorable disease in juvenile patients, are malignant lesions and require treatment as such. Lymph node metastases in melanoma occur at lower rates in older patients compared with younger counterparts, yet the rate of metastases is still high. Age appears to play an important role in the development and progression of melanoma, and understanding the differences across age populations is important when counseling patients.
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Affiliation(s)
- Adrienne B Shannon
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Maloney, Philadelphia, PA 19104, USA.
| | - Yun Song
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Maloney, Philadelphia, PA 19104, USA
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 Founders, Philadelphia, PA 19104, USA
| | - Giorgos C Karakousis
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Silverstein, Philadelphia, PA 19104, USA
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7
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Ferrari A, Lopez Almaraz R, Reguerre Y, Cesen M, Bergamaschi L, Indini A, Schneider DT, Godzinski J, Bien E, Stachowicz-Stencel T, Eigentler TK, Chiaravalli S, Krawczyk MA, Pappo A, Orbach D, Bisogno G, Brecht IB. Cutaneous melanoma in children and adolescents: The EXPeRT/PARTNER diagnostic and therapeutic recommendations. Pediatr Blood Cancer 2021; 68 Suppl 4:e28992. [PMID: 34174159 DOI: 10.1002/pbc.28992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022]
Abstract
Cutaneous melanoma is rare in children and, like other very rare pediatric tumors, it suffers from a shortage of knowledge and clinical expertise. The clinical management of pediatric melanoma is often challenging. Its clinical and pathological diagnosis may be difficult, and there is no standard treatment. In the absence of specific treatment guidelines, young patients are generally treated following the same principle as for adults, but concern remains about their access to clinical trials and new drugs, which have been shown to dramatically change the natural history of advanced melanoma. This paper presents the internationally recognized recommendations for the diagnosis and treatment of children and adolescents with cutaneous melanoma, established by the European Cooperative Study Group for Pediatric Rare Tumors (EXPeRT) within the EU-funded project called PARTNER (Paediatric Rare Tumours Network - European Registry). Main recommendations for melanoma are to discuss pediatric patients in multidisciplinary teams that include both pediatric oncologists and specialists in adult melanoma; to enroll patients in prospective trials, if available; to collect data in national-international databases; and to develop an effective international collaboration between pediatric and adult melanoma groups in order to facilitate the transfer of potentially effective new agents from the adult to the pediatric setting.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Yves Reguerre
- Pediatric Hematology-Oncology Department, Centre Hospitalier Universitaire, Saint Denis de La Réunion, France
| | - Maja Cesen
- University Medical Center, Ljubljana, Slovenia
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Alice Indini
- Medical Oncology Unit, IRCCS Foundation Ca' Granda Maggiore Hospital Policlinic, Milan, Italy
| | | | - Jan Godzinski
- Department of Pediatric Surgery, Marciniak Hospital, Wroclaw, Poland
| | - Ewa Bien
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | | | - Thomas K Eigentler
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Malgorzata A Krawczyk
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | - Alberto Pappo
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France
| | - Gianni Bisogno
- Hematology-Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Ines B Brecht
- Pediatric Hematology and Oncology, Children's Hospital, Eberhard-Karls-University, Tuebingen, Germany
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8
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Grant CN, Aldrink J, Lautz TB, Tracy ET, Rhee DS, Baertschiger RM, Dasgupta R, Ehrlich PF, Rodeberg DA. Lymphadenopathy in children: A streamlined approach for the surgeon - A report from the APSA Cancer Committee. J Pediatr Surg 2021; 56:274-281. [PMID: 33109346 DOI: 10.1016/j.jpedsurg.2020.09.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/19/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND/PURPOSE Lymphadenopathy is a common complaint in children. Pediatric surgeons are often called upon to evaluate, treat, and/or biopsy enlarged lymph nodes. With many nonsurgical causes in the differential diagnosis, the surgeon plays the important role of providing reassurance and timely diagnosis while minimizing the pain and morbidity associated with surgical interventions in children. The purpose of this summary paper is to provide a management guide for surgeons working up children with lymphadenopathy. MATERIALS/METHODS The English language literature was searched for "lymphadenopathy in children". All manuscript types were considered for review, regardless of medical specialty, with emphasis placed on published guidelines, algorithms, and reviews. After thorough review of these manuscripts and cross-referencing of their bibliographies, the attached algorithm was developed, with emphasis on the role and timing of surgical intervention. RESULTS The APSA Cancer Committee developed the attached algorithm to fill a gap in the surgical literature. It outlines lymphadenopathy workup and treatment with emphasis on the role and timing of surgical intervention. CONCLUSION This review defines and summarizes the common etiologies and presentations of lymphadenopathy in children, and offers a straightforward algorithm for evaluation of and treatment with an emphasis on malignancy risk and surgical management. TYPE OF STUDY Summary paper. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Christa N Grant
- Division of Pediatric Surgery, Penn State Children's Hospital, Department of Surgery, Milton S. Hershey Medical Center, Hershey, PA.
| | - Jennifer Aldrink
- Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC
| | - Daniel S Rhee
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH
| | - Peter F Ehrlich
- Division of Pediatric Surgery, Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor, MI
| | - David A Rodeberg
- Division of Pediatric Surgery, East Carolina Medical Center, Greenville, NC
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9
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AlZahrani F, Kuzel P, Metelitsa A, Smylie M, Dover D, Fiorillo L. A Clinicoepidemiological Study of Melanoma in Young Patients (20 Years of Age or Less) in Alberta, Canada, From 1992 to 2011. J Cutan Med Surg 2020; 25:133-141. [PMID: 33095029 DOI: 10.1177/1203475420963658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The epidemiological trends of malignant melanoma have been well described in the literature. However, there remains a paucity of population-based studies assessing melanoma epidemiology in our younger patients (20 years of age or less). Other studies indicate that melanoma incidence has risen in pediatric populations over the last several decades and that these tumors may display different clinical characteristics from those arising in adult populations. We conducted a retrospective, population-based analysis of all incident cases of melanoma occurring in young patients aged ≤20 years in Alberta from 1992 to 2011. Information, including patient age, sex, anatomical location, date of diagnosis, histological subtype (if available), level of invasion, and date of death (if applicable), was obtained from the Alberta Cancer Registry. All cases occurring during a 10-year period from 1993 to 2011 have been reviewed. A total of 71 cases were diagnosed during this time (63% female and 37% male). Age range was 0-20 years (mean of 17.5 years). Truncal melanomas made up 36% of cases, while 28% occurred on the lower limbs, 17% on the upper limbs, and 18% in the head and neck region. Average Breslow thickness was 1.97 mm; 67% of tumors were less than 1 mm thick. Unfortunately, 8 of 71 patients died from their disease. Overall, the incidence of melanoma in patients aged ≤20 years appeared to decrease in Alberta in the past 20 years; however, there has been an increase in the thickness of melanoma at diagnosis, which needs to be addressed.
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Affiliation(s)
- Fatmah AlZahrani
- 3158 Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Paul Kuzel
- 3158 Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Andrei Metelitsa
- 2129 Division of Dermatology, University of Calgary, Alberta, Canada.,Department of Dermatology, Beacon Dermatology, Calgary, Alberta, Canada
| | - Michael Smylie
- Division of Medical Oncology, Department of Oncology, University of Alberta, Edmonton, Canada
| | - Douglas Dover
- Alberta Health and Wellness, Community and Population Health Division, Surveillance and Assessment, University of Alberta, Edmonton, Alberta, Canada
| | - Loretta Fiorillo
- 3158 Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, Canada
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10
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The prognostic value of tumor mitotic rate in children and adolescents with cutaneous melanoma: A retrospective cohort study. J Am Acad Dermatol 2020; 82:910-919. [DOI: 10.1016/j.jaad.2019.10.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/29/2022]
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11
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Abstract
Melanoma accounts for 7% of all cancers in adolescents ages 15-19 years but is an unexpected malignancy in younger children. The prevalence of malignant melanoma is very rare in children ages 1-4 years, but certain non-modifiable risk factors such as xeroderma pigmentosum, congenital melanocytic nevus syndrome and other inherited traits increase the risk for its development in these young children. Recent genomic studies have identified characteristics of pediatric melanoma that differ from conventional melanoma seen in adults. In this review the authors inform on the types of melanoma seen in children and adolescents, discuss similarities and differences in melanoma between children and adults, and discuss the role of imaging in the care of these children.
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Affiliation(s)
- Sue C Kaste
- Departments of Diagnostic Imaging and Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MSN 220, Memphis, TN, 38105-3678, USA.
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA.
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12
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Quinlan CS, Capra M, Dempsey M. Paediatric malignant melanoma in Ireland: A population study and review of the literature. J Plast Reconstr Aesthet Surg 2019; 72:1388-1395. [PMID: 31101426 DOI: 10.1016/j.bjps.2019.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 11/18/2018] [Accepted: 03/30/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Malignant melanoma is increasing in frequency worldwide; however, this disease is rare in children. As large-scale studies on paediatric melanoma are lacking, management is currently often based upon the understanding of the disease process in adults. The aim of this study was to characterise cases of paediatric melanoma diagnosed in the Republic of Ireland over a 21-year period. METHODS This was a retrospective, multicentre study using national data provided by the National Cancer Registry of Ireland and individual practitioners. RESULTS Twenty-four cases of melanoma treated in 11 different centres were included in the study. The median patient age at diagnosis was 15 years. The majority of cases arose on the limbs. The median Breslow thickness in patients of the pre-pubertal age group was 8.25 mm, while in children more than 13 years, it was 1.65 mm. Eight patients had disease recurrence and five patients died. CONCLUSION The diagnosis of melanoma remains rare in children. This study contributes to our current understanding of malignant melanoma in paediatric patients; however, further investigation of the disease characteristics in this group is necessary to achieve optimal management of these cases and therefore improve outcomes.
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Affiliation(s)
- Christine S Quinlan
- Department of Plastic and Reconstructive Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
| | - Michael Capra
- Department of Paediatric Oncology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - Marlese Dempsey
- Department of Plastic and Reconstructive Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
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13
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Bagnoni G, Fidanzi C, D'Erme AM, Viacava P, Leoni M, Strambi S, Calani C, Bertocchini A, Morganti R, Spinelli C. Melanoma in children, adolescents and young adults: anatomo-clinical features and prognostic study on 426 cases. Pediatr Surg Int 2019; 35:159-165. [PMID: 30411144 DOI: 10.1007/s00383-018-4388-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE This study was conducted to determine the difference in anatomo-pathological and prognostic features of cutaneous melanoma in children, adolescents and young adults. METHODS This is a retrospective review on 383 young patients ≤ 39 years of age with cutaneous melanoma, in a period from 2006 to 2016 in Area Vasta Nord Ovest, Tuscany, Italy. We subdivided patients in three groups (children ≤ 14 years, adolescents 15-21 years, young adults 22-39 years). We correlated all the anatomo-pathological parameters with age groups. RESULTS We identified a total of 426 cases of cutaneous melanoma on an overall total of 383 patients. Mean age at diagnosis for all the patients ≤ 39 years of age was 31.2 years: in group A was 11.2 years, in group B 19.2 years and in group C 32.5 years. Incidence, in the subjects between 0 and 14 years, is 14 cases per million inhabitants, between 15 and 21 years of 145, and between 22 and 39 years of 394. Global incidence was 1.6 case per million for group A, 8.9 cases per million for group B, 105 cases per million for group C. No statistically significative correlation could be described for clinical parameters and age groups. CONCLUSIONS Incidence of melanoma in our casuistry results as the highest in the world. These data open new study for this kind of cancer.
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Affiliation(s)
- Giovanni Bagnoni
- Melanoma and Skin Cancer Unit AVNO (Area Vasta Nord Ovest) and Unit of Dermatology, Livorno Hospital, Livorno, Italy
| | - Cristian Fidanzi
- Melanoma and Skin Cancer Unit AVNO (Area Vasta Nord Ovest) and Unit of Dermatology, Livorno Hospital, Livorno, Italy
| | - Angelo Massimiliano D'Erme
- Melanoma and Skin Cancer Unit AVNO (Area Vasta Nord Ovest) and Unit of Dermatology, Livorno Hospital, Livorno, Italy
| | | | - Matteo Leoni
- Pediatric, Adolescent and Young Adults Surgery Division, Department of Surgical, Medical, Pathological, Molecular and Critical Area, University of Pisa, Pisa, Italy
| | - Silvia Strambi
- Pediatric, Adolescent and Young Adults Surgery Division, Department of Surgical, Medical, Pathological, Molecular and Critical Area, University of Pisa, Pisa, Italy
| | - Chiara Calani
- Pediatric, Adolescent and Young Adults Surgery Division, Department of Surgical, Medical, Pathological, Molecular and Critical Area, University of Pisa, Pisa, Italy
| | - Alessia Bertocchini
- Pediatric, Adolescent and Young Adults Surgery Division, Department of Surgical, Medical, Pathological, Molecular and Critical Area, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Statistical Support to Clinical Trials Department, University of Pisa, Pisa, Italy
| | - Claudio Spinelli
- Pediatric, Adolescent and Young Adults Surgery Division, Department of Surgical, Medical, Pathological, Molecular and Critical Area, University of Pisa, Pisa, Italy.
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14
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Indini A, Brecht I, Del Vecchio M, Sultan I, Signoroni S, Ferrari A. Cutaneous melanoma in adolescents and young adults. Pediatr Blood Cancer 2018; 65:e27292. [PMID: 29968969 DOI: 10.1002/pbc.27292] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/24/2022]
Abstract
Cutaneous melanoma is rare in children, but has greater incidence in adolescents and young adults (AYAs). Diagnosis may be challenging due to its rarity in these age groups. Few studies have specifically addressed the topic of AYA melanoma. Though young-age melanoma may have particular biological characteristics, available data suggest that its clinical history is similar to that of adults. However, advances in treatment of adult melanoma have not been reflected in the treatment of AYAs. There is no standard treatment, and access to clinical trials is difficult for AYAs. Further efforts are needed to overcome these issues by improving cooperation with experts on adult melanoma.
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Affiliation(s)
- Alice Indini
- Melanoma Medical Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Ines Brecht
- Department of Pediatric Hematology and Oncology, University of Tubingen, Tubingen, Germany
| | - Michele Del Vecchio
- Melanoma Medical Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Iyad Sultan
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Stefano Signoroni
- Unit of Hereditary Digestive Tract Tumours, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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15
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Parikh PP, Tashiro J, Rubio GA, Sola JE, Neville HL, Hogan AR, Perez EA. Incidence and outcomes of pediatric extremity melanoma: A propensity score matched SEER study. J Pediatr Surg 2018; 53:1753-1760. [PMID: 29602554 DOI: 10.1016/j.jpedsurg.2018.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 02/19/2018] [Accepted: 03/04/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a paucity of literature on treatment of melanoma in children with surgical management extrapolated from adult experience. The incidence and clinical outcomes of pediatric extremity melanoma were studied. METHODS SEER registry was analyzed between 1973 and 2010 for patients <20years old with extremity melanoma. Multivariate and propensity-score matched analyses were performed to identify independent predictors of survival. RESULTS Overall, 917 patients were identified with an age-adjusted incidence of 0.2/100,000 persons, annual percent change 0.96. Most had localized disease (77%), histology revealing melanoma-not otherwise specified (52%). Surgical procedures performed included wide local excision (50%), excisional biopsy (32%), lymphadenectomy (LA) (28%), and sentinel lymph node biopsy (SLNB) (15%). Overall, 30-year disease specific mortality was 7% with lower survival for extremity melanoma (90%), males (89%), nodular histology (69%), and distant disease (36%) (all P<0.05). Post-treatment multivariate analysis revealed localized disease (HR 9.76; P=0.006) as an independent prognosticator of survival; earlier diagnostic years 1988-1999 (HR 2.606; P=0.017) were a negative prognosticator of survival. Propensity-score matched analysis found no difference in survival between SLNB/LA vs no sampling for regional/distant disease. CONCLUSIONS Pediatric extremity melanoma in SEER demonstrate no survival advantage between children undergoing sampling procedures vs no sampling for regional/distant disease. TYPE OF STUDY Retrospective, prognostic study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Punam P Parikh
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida.
| | - Jun Tashiro
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Gustavo A Rubio
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Juan E Sola
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Holly L Neville
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Anthony R Hogan
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Eduardo A Perez
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
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16
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Lam PH, Obirieze AC, Ortega G, Li BS, Purnell SD, Weeks CB, Ehanire ID, Oyetunji TA, Wilson LL. An Age-Based Analysis of Pediatric Melanoma: Staging, Surgery, and Mortality in the Surveillance, Epidemiology, and End Results Database. Am Surg 2018. [DOI: 10.1177/000313481808400528] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The pediatric melanoma population is not well described, and current guidelines for their management are not well defined. Our study aims to identify this population, treatment modalities, and outcomes using a national population-based database. We reviewed the Surveillance, Epidemiology, and End Results database (2004–2008). Patients ≤21 years old with melanoma were included and grouped into ≤12 years of age, 13 to 18 years, and 19 to 21 years. Clinical characteristics were analyzed across the groups. A total of 1255 patients were included: 52.7 per cent were 19 to 21 years of age, 36.3 per cent were 13 to 18 years of age, and 11.0 per cent were ≤12 years of age. The 19- to 21-year-olds had the highest proportion of stage I (50.5%) versus ≤12 years of age (31.9%); the ≤12-year-olds had the highest proportion of stage IV (3.6%) versus 19 to 21 years of age (0.9%), P < 0.001. The 19- to 21-year-olds had the highest proportion receiving wide local excisions only (34.8%) versus ≤12 years of age (26.4%); the ≤12-year-olds had the highest proportion of patients without any surgeries (16.0%) versus 13 to 18 years of age (9.4%), P = 0.169. On adjusted analysis, the 19- to 21-year-olds had worse survival compared with ≤12 years of age (hazard ratio: 5.26, P = 0.017, 95% confidence interval 1.34–20.65). Disparities were found in the ≤12-year-old melanoma population, as they had later stage melanomas, less invasive surgery, and lower survival. Clearer prognostic factors are needed to better elucidate their management.
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Affiliation(s)
- Patrick H. Lam
- Howard University College of Medicine, Washington, District of Columbia
| | - Augustine C. Obirieze
- Department of Surgery, Outcomes Research Center, Howard University College of Medicine, Washington, District of Columbia
| | - Gezzer Ortega
- Department of Surgery, Outcomes Research Center, Howard University College of Medicine, Washington, District of Columbia
| | - Becky S. Li
- Howard University College of Medicine, Washington, District of Columbia
| | | | - Claudia B. Weeks
- Department of Surgery, Outcomes Research Center, Howard University College of Medicine, Washington, District of Columbia
| | - Imudia D. Ehanire
- Department of Surgery, Howard University College of Medicine, Washington, District of Columbia
| | - Tolulope A. Oyetunji
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Lori L. Wilson
- Division of Surgical Oncology, Department of Surgery, Howard University College of Medicine, Washington, District of Columbia
- Howard University Cancer Center, Howard University Hospital, Washington, District of Columbia
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Stefanaki C, Chardalias L, Soura E, Katsarou A, Stratigos A. Paediatric melanoma. J Eur Acad Dermatol Venereol 2017; 31:1604-1615. [PMID: 28449284 DOI: 10.1111/jdv.14299] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/03/2017] [Indexed: 02/06/2023]
Abstract
Paediatric melanoma, although rare, is the most common skin cancer in children. Our current knowledge on paediatric melanoma incidence trends is expanding, as several studies have addressed this issue with conflicting results. Known risk factors for paediatric melanoma include family history of melanoma, a previous history of malignancy, large congenital nevi, numerous melanocytic nevi, sunburns, increased UV exposure and a sun-sensitive phenotype. In younger children, melanoma more often presents with atypical features, such as a changing, amelanotic or uniformly coloured, often bleeding lesion, not fulfilling in most cases the conventional ABCDE criteria. The major differential diagnoses are melanocytic nevi, proliferative nodules in congenital nevi and atypical Spitz tumours. Moreover, in the younger age group non-Caucasian children are over-represented, tumours tend to be thicker and lymph nodes are often involved. Despite the frequent diagnosis at an advanced stage, the overall survival is fair in paediatric melanoma. Specific guidelines for management of melanoma in children do not exist, and most often the disease is treated similarly to melanoma in adults.
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Affiliation(s)
- C Stefanaki
- University Department of Dermatology - Venereology, "Andreas Sygros" Hospital, Athens, Greece
| | - L Chardalias
- University Department of Dermatology - Venereology, "Andreas Sygros" Hospital, Athens, Greece
| | - E Soura
- University Department of Dermatology - Venereology, "Andreas Sygros" Hospital, Athens, Greece
| | - A Katsarou
- University Department of Dermatology - Venereology, "Andreas Sygros" Hospital, Athens, Greece
| | - A Stratigos
- University Department of Dermatology - Venereology, "Andreas Sygros" Hospital, Athens, Greece
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18
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Saiyed FK, Hamilton EC, Austin MT. Pediatric melanoma: incidence, treatment, and prognosis. Pediatric Health Med Ther 2017; 8:39-45. [PMID: 29388632 PMCID: PMC5774597 DOI: 10.2147/phmt.s115534] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The purpose of this review is to outline recent advancements in diagnosis, treatment, and prevention of pediatric melanoma. Despite the recent decline in incidence, it continues to be the deadliest form of skin cancer in children and adolescents. Pediatric melanoma presents differently from adult melanoma; thus, the traditional asymmetry, border irregularity, color variegation, diameter >6 mm, and evolution (ABCDE) criteria have been modified to include features unique to pediatric melanoma (amelanotic, bleeding/bump, color uniformity, de novo/any diameter, evolution of mole). Surgical and medical management of pediatric melanoma continues to derive guidelines from adult melanoma treatment. However, more drug trials are being conducted to determine the specific impact of drug combinations on pediatric patients. Alongside medical and surgical treatment, prevention is a central component of battling the incidence, as ultraviolet (UV)-related mutations play a central role in the vast majority of pediatric melanoma cases. Aggressive prevention measures targeting sun safety and tanning bed usage have shown positive sun-safety behavior trends, as well as the potential to decrease melanomas that manifest later in life. As research into the field of pediatric melanoma continues to expand, a prevention paradigm needs to continue on a community-wide level.
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Affiliation(s)
- Faiez K Saiyed
- Department of Pediatric Surgery, McGovern Medical School
| | | | - Mary T Austin
- Department of Pediatric Surgery, McGovern Medical School
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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19
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Réguerre Y, Vittaz M, Orbach D, Robert C, Bodemer C, Mateus C, Plantaz D, Plouvier E, Lutz P, Rakotonjanahary J, Fraitag S, Martin L. Cutaneous malignant melanoma in children and adolescents treated in pediatric oncology units. Pediatr Blood Cancer 2016; 63:1922-7. [PMID: 27348579 DOI: 10.1002/pbc.26113] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Recent progress in the understanding of tumor biology and new targeted therapies has led to improved survival in adults with malignant melanoma (MM). MM is rare in children, especially before puberty. We report here our experience with pediatric patients with MM, describe the clinical presentation, treatment and evolution, and compare prepubescent and postpubescent disease. METHODS A retrospective, descriptive, national multicenter study was undertaken of 52 cases of MM in children and adolescents. Demographic, histopathology, treatment evolution data, and survival distributions are described. RESULTS Median age was 15 years (5-18). The tumors were often amelanotic (45%) and raised (83%), and Breslow thickness was greater than 4 mm in 35% of cases. Histological examination showed superficial spreading (n = 16) or spitzoid (n = 16) or nodular (n = 9) pattern. Twelve children (23%) were less than 10 years of age. The spitzoid histotype was more frequent in prepubescent children (seven of 12). Seventeen patients relapsed, of whom four had skin lesions initially diagnosed as benign. Ten patients died after relapse. Five-year event-free survival and overall survival were 62.7% (95% confidence interval [CI]: 45.3-76) and 75.5% (95% CI: 56.8-87.1), respectively. CONCLUSIONS MM appears to be different in prepubescent children, of whom most had a spitzoid histotype. Diagnosis can be difficult, leading to delay in treatment. New biological tools to identify targets for treatment in MM and to differentiate spitzoid melanomas from Spitz nevi now exist. As effective targeted therapies are now available, we recommend requesting biological examination of all melanocyte-derived skin lesions in children that could be malignant.
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Affiliation(s)
- Yves Réguerre
- Oncology and Hematology Unit, CHU de Saint Denis de La Réunion, Saint Denis, France. French Pediatric Rare Tumor Group (groupe Fracture).
| | - Marie Vittaz
- Pediatric Departement, CH Le Mans, Le Mans, France
| | - Daniel Orbach
- Department of Pediatrics, Adolescent, Young Adult Oncology, Institut Curie, Paris, France. French Pediatric Rare Tumor group (groupe Fracture)
| | - Caroline Robert
- Dermatology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Christine Bodemer
- Dermatology Department, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christina Mateus
- Dermatology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Dominique Plantaz
- Oncology and Hematology Unit, Grenoble University Hospital, Grenoble, France
| | - Emmanuel Plouvier
- Oncology and Hematology Unit, Besançon University Hospital, Besançon, France
| | - Patrick Lutz
- Oncology and Hematology Unit, Strasbourg University Hospital, Strasbourg, France
| | | | - Sylvie Fraitag
- Pathology Department, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ludovic Martin
- Dermatology Department, Angers University Hospital, Angers, France
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20
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Lorimer PD, White RL, Walsh K, Han Y, Kirks RC, Symanowski J, Forster MR, Sarantou T, Salo JC, Hill JS. Pediatric and Adolescent Melanoma: A National Cancer Data Base Update. Ann Surg Oncol 2016; 23:4058-4066. [PMID: 27364504 DOI: 10.1245/s10434-016-5349-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Studies suggest that the biology of pediatric and adolescent melanoma differs from that of adult disease. We report the largest series to date examining the natural history of pediatric and adolescent melanoma. We aim to elucidate the natural history of pediatric and adolescent melanoma and to examine the appropriateness of diagnostic and therapeutic modalities developed for adults and that are currently being used in children. METHODS A retrospective cohort study was conducted of patients with an index diagnosis of cutaneous non-metastatic melanoma from 1998 to 2011 using the National Cancer Data Base (NCDB; n = 420,416). Three age-based cohorts were analyzed: 1-10 years (pediatric), 11-20 years (adolescent), and ≥21 years (adult). Multivariate analyses were used to identify factors associated with overall survival (OS). RESULTS Pediatric melanoma patients have longer OS than their adolescent (hazard ratio [HR] 0.50, 95 % CI 0.25-0.98) and adult counterparts (HR 0.11, 95 % CI 0.06-0.21). Adolescents have longer OS than adults. No difference was found in OS in pediatric patients who are node-positive versus node-negative. In pediatric patients, sentinel lymph node biopsy and completion lymph node dissection are not associated with increased OS. In adolescents, nodal positivity is a significant negative prognostic indicator (HR 4.82, 95 % CI 3.38-6.87). CONCLUSIONS Age-based differences in melanoma outcomes warrant different considerations for diagnostic and therapeutic approaches in each group in order to maximize quality of life while minimizing complications and costs. Prospective, multicenter studies should evaluate the role of diagnostic procedures for pediatric patients.
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Affiliation(s)
- Patrick D Lorimer
- Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - Richard L White
- Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - Kendall Walsh
- Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - Yimei Han
- Department of Biostatistics, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - Russell C Kirks
- Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - James Symanowski
- Department of Biostatistics, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - Meghan R Forster
- Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - Terry Sarantou
- Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - Jonathan C Salo
- Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - Joshua S Hill
- Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA.
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21
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Abstract
Spitzoid melanomas (SM) and atypical Spitz tumors (AST) are rare pediatric neoplasms. We performed a retrospective, single-institution review and report our institutional experience. We identified 10 patients (median age: 12.5 years). A sentinel node biopsy (SNB) was performed in 8/10 (80%) patients, and interestingly 7/8 (87.5%) were found to be positive for malignant cells. A complete regional lymphadenectomy was performed in all SNB-positive patients, but only 2/8 (25%) were found to have additional lymph node spread. Adjuvant therapy was administered in 5/8 SLNB-positive and 2/2 (100%) regional LN-positive cases. All patients had excellent long-term outcomes (100% survival). This report highlights the excellent outcomes associated with SNB + pediatric SM and AST.
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Affiliation(s)
- Sandeep Batra
- Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA.,Division of Pediatric Hematology-Oncology, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA.,Hematopoiesis, Hematologic Malignancies & Immunology, Indiana University Melvin & Bren Simon Cancer Center, 535 Barnhill Drive, Indianapolis, IN 46202, USA.,Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA
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22
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Brecht IB, Garbe C, Gefeller O, Pfahlberg A, Bauer J, Eigentler TK, Offenmueller S, Schneider DT, Leiter U. 443 paediatric cases of malignant melanoma registered with the German Central Malignant Melanoma Registry between 1983 and 2011. Eur J Cancer 2015; 51:861-8. [PMID: 25794606 DOI: 10.1016/j.ejca.2015.02.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/09/2015] [Accepted: 02/12/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Malignant melanoma is a very rare paediatric tumour. This study was performed in order to understand clinical features and prognosis of malignant melanoma in children and adolescents. METHODS 443 patients ⩽ 18 years of age with malignant melanoma were prospectively registered with the German Central Malignant Melanoma Registry between 1983 and 2011. Cases were collected from 58 participating centres. 276 paediatric cases with a follow-up >3 months were evaluated for survival probabilities and prognostic factors by Kaplan-Meier method. RESULTS Age of diagnosis ranged from 3 months to 18 years (median age 16 years). The male to female ratio was 0.8 (202 male, 240 female). Most melanoma were located at the trunk (n = 195) and the lower extremity (n = 114). Patients with >3 months of follow-up (median 55 months) showed an overall survival (OS) of 94.8% in 5 years. Survival according to tumour stage was 98.5% for stage I (n = 190), 91.1% for stage II (n = 39) and 53.0% for stage III/IV tumours (n = 11). Worse outcome was seen in patients with nodular melanoma (OS 77.9%, n = 42) compared to superficial spread histotype (OS 100%, n = 138) or other histotype (OS 96.9%, n = 88) (p < 0.0001), in case of thicker tumours (Clark level IV or V, OS 87.1%, n = 84) compared to thinner tumours (Clark level I, II, III, OS 99.1%, n = 164) (p = 0.0008) and in case of ulceration (OS 65.6%, n = 17) compared to no ulceration (OS 99.2%, n = 182). CONCLUSION Patient and tumour characteristics in paediatric melanoma patients show no evident differences to adult melanoma cases. The same clinical approach as in adults should be used.
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Affiliation(s)
- Ines B Brecht
- Pediatric Hematology and Oncology, University Children's Hospital Erlangen, Germany.
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Central Malignant Melanoma Registry of the German Dermatological Society, University Hospital Tuebingen, Germany
| | | | | | - Jürgen Bauer
- Center for Dermatooncology, Department of Dermatology, Central Malignant Melanoma Registry of the German Dermatological Society, University Hospital Tuebingen, Germany
| | - Thomas K Eigentler
- Center for Dermatooncology, Department of Dermatology, Central Malignant Melanoma Registry of the German Dermatological Society, University Hospital Tuebingen, Germany
| | - Sonja Offenmueller
- Pediatric Hematology and Oncology, University Children's Hospital Erlangen, Germany
| | | | - Ulrike Leiter
- Center for Dermatooncology, Department of Dermatology, Central Malignant Melanoma Registry of the German Dermatological Society, University Hospital Tuebingen, Germany
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Abstract
PURPOSE OF REVIEW To inform pediatricians of the challenges of detection of melanoma in children and adolescents as well as to instruct on proper biopsy technique of suspicious lesions. RECENT FINDINGS The incidence of melanoma in children and adolescents is on the rise with an average increase of 2% per year. Rates of change are higher in adolescent girls and locations with low UV-B exposure. Standard Amelanotic, Bleeding, Bump, Color uniformity, De novo, any Diameter (ABCD) detection criteria fail to detect most childhood melanomas. Tumor thickness and sentinel lymph node status are the most important prognostic factors. Artificial tanning use is prevalent among adolescent girls and likely contributes to the growing incidence of melanoma in this group. SUMMARY Childhood melanoma is often amelanotic and may also appear as raised or ulcerated lesions commonly mistaken for warts or other benign skin conditions. Excision and full-thickness punch biopsies are indicated for suspicious lesions, whereas shaves and small punch biopsies are to be avoided. Pediatric patients more frequently have positive sentinel lymph nodes and increased tumor thickness, yet similar survival compared with adults.
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Balch CM, Thompson JF, Gershenwald JE, Soong SJ, Ding S, McMasters KM, Coit DG, Eggermont AMM, Gimotty PA, Johnson TM, Kirkwood JM, Leong SP, Ross MI, Byrd DR, Cochran AJ, Mihm MC, Morton DL, Atkins MB, Flaherty KT, Sondak VK. Age as a predictor of sentinel node metastasis among patients with localized melanoma: an inverse correlation of melanoma mortality and incidence of sentinel node metastasis among young and old patients. Ann Surg Oncol 2014; 21:1075-81. [PMID: 24531700 DOI: 10.1245/s10434-013-3464-x] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Indexed: 01/21/2023]
Abstract
PURPOSE We have previously reported that older patients with clinical stage I and II primary cutaneous. Melanoma had lower survival rates compared to younger patients. We postulated that the incidence of nodal metastasis would therefore be higher among older melanoma patients. METHODS The expanded American Joint Committee on Cancer melanoma staging database contains a cohort of 7,756 melanoma patients who presented without clinical evidence of regional lymph node or distant metastasis and who underwent a sentinel node biopsy procedure as a component of their staging assessment. RESULTS Although older patients had primary melanoma features associated with more aggressive biology, we paradoxically observed a significant decrease in the incidence of sentinel node metastasis as patient age increased. Overall, the highest incidence of sentinel node metastasis was 25.8 % in patients under 20 years of age, compared to 15.5 % in patients 80 years and older (p < 0.001). In contrast, 5-year mortality rates for clinical stage II patients ranged from a low of 20 % for those 20-40 years of age up to 38 % for those over 70 years of age. Patient age was an independent predictor of sentinel node metastasis in a multifactorial analysis (p < 0.001). CONCLUSIONS Patients with clinical stage I and II melanoma under 20 years of age had a higher incidence of sentinel lymph node metastasis but, paradoxically, a more favorable survival outcome compared to all other age groups. In contrast, patients >70 years had the most aggressive primary melanoma features and a higher mortality rate compared to all other age groups but a lower incidence of sentinel lymph node metastasis.
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Affiliation(s)
- Charles M Balch
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA,
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25
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Ferrari A, Bisogno G, Cecchetto G, Santinami M, Maurichi A, Bono A, Vajna De Pava M, Pierani P, Bertolini P, Rossi CR, De Salvo GL. Cutaneous melanoma in children and adolescents: the Italian rare tumors in pediatric age project experience. J Pediatr 2014; 164:376-82.e1-2. [PMID: 24252782 DOI: 10.1016/j.jpeds.2013.10.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 08/19/2013] [Accepted: 10/03/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe a series of cutaneous melanoma in children collected by the Italian Rare Tumors in Pediatric Age project. STUDY DESIGN From 2000 to 2012, 54 patients younger than 18 years of age were prospectively registered and treated at 12 Italian pediatric centers on the basis of the same diagnostic/therapeutic recommendations and with the same forms to record clinical data. RESULTS Considering the estimated annual incidence in Italy, the registered cases accounted for 30% of those expected in children and 10% of adolescents. Clinically, 47% of the tumors were amelanotic and 81% were raised, 39% of cases had tumor thickness >2 mm, and 36% had lymph node involvement. For the whole series, 5-year event-free survival and overall survival rates were 75.2% and 84.6%, respectively. Patient survival correlated with tumor stage and ulceration. No relapses were recorded for T1-2 (thickness <2 mm), N0, and stage 0-I-II cases. CONCLUSION We suggest that the variables influencing survival in children with melanoma are the same as for adults, the clinical approach used in adults is feasible in children, and pediatric cases are more likely to have advanced disease at diagnosis but similar survival. New effective drugs are needed for advanced disease, and biological studies and international cooperative schemes are warranted.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | - Gianni Bisogno
- Hematology-Oncology Division, Department of Pediatrics, Padova University Hospital, Padova, Italy
| | - Giovanni Cecchetto
- Pediatric Surgery, Department of Pediatrics, Padova University Hospital, Padova, Italy
| | - Mario Santinami
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Andrea Maurichi
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Aldo Bono
- Day Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marco Vajna De Pava
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Paolo Pierani
- Department of Pediatrics, University of Ancona, Ancona, Italy
| | - Patrizia Bertolini
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria di Parma, Parma, Italy
| | - Carlo Riccardo Rossi
- Melanoma and Sarcoma Unit, Department of Surgery, Padova University Hospital, Padova, Italy
| | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
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26
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Reed D, Kudchadkar R, Zager JS, Sondak VK, Messina JL. Controversies in the evaluation and management of atypical melanocytic proliferations in children, adolescents, and young adults. J Natl Compr Canc Netw 2014; 11:679-86. [PMID: 23744867 DOI: 10.6004/jnccn.2013.0087] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The rising incidence of melanoma in children has brought increased attention to the clinical and pathologic diagnosis of pigmented lesions in the pediatric age group. Although melanoma in infancy and early childhood is often associated with large congenital nevi, in older children and teenagers it is most often sporadic, occurring in patients with a low skin phototype and substantial sun exposure. The rarity of this potentially fatal disorder demands astute clinical attention and a high index of suspicion for atypical lesions in pediatric patients. The challenges include the difficult decision of whether to biopsy and an often equivocal pathologic diagnosis. These diagnostically challenging and equivocal lesions lead to a degree of uncertainty regarding additional workup, prognosis, potential therapy, and follow-up plans. Consultation with a specialty dermatopathologist can be very helpful, and advanced molecular diagnostic techniques may be used in selected circumstances. Although still controversial, good evidence exists to justify a role for sentinel lymph node biopsy. Patients with atypical melanocytic proliferations have a high rate of positive sentinel lymph nodes; however, their outcomes are clearly better than in similarly staged adults with conventional melanoma. With the multiple variables involved and the relative lack of prospectively derived evidence, clinical decision-making is challenging and patients and families may experience considerable stress. This article provides data and weighs the pros and cons of a rationale for decision-making in pediatric and young adult patients with diagnostically challenging melanocytic lesions.
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Affiliation(s)
- Damon Reed
- Department of a Sarcoma Oncology, Moffitt Cancer Center, Tampa, Florida 33612, USA.
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27
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Han D, Turner LM, Reed DR, Messina JL, Sondak VK. The prognostic significance of lymph node metastasis in pediatric melanoma and atypical melanocytic proliferations. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.13.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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28
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Hinkle NM, Malkan AD, Sandoval JA. The Application and Indications for Sentinel Lymph Node Biopsy in Pediatric Solid Tumors: Current Status and Future Directions. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ijcm.2014.518145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Averbook BJ, Lee SJ, Delman KA, Gow KW, Zager JS, Sondak VK, Messina JL, Sabel MS, Pittelkow MR, Ecker PM, Markovic SN, Swetter SM, Leachman SA, Testori A, Curiel-Lewandrowski C, Go RS, Jukic DM, Kirkwood JM. Pediatric melanoma: analysis of an international registry. Cancer 2013; 119:4012-9. [PMID: 24022819 PMCID: PMC4096292 DOI: 10.1002/cncr.28289] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 12/24/2012] [Accepted: 01/24/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND The management of pediatric melanoma (PM) has largely been extrapolated from adult data. However, the behavior of PM appears to differ from its adult counterparts. Therefore, an international PM registry was created and analyzed. METHODS Twelve institutions contributed deidentified clinicopathologic and outcome data for patients diagnosed with PM from 1953 through 2008. RESULTS Overall survival (OS) data were reported for 365 patients with invasive PM who had adequate follow-up data. The mean age of the patients was 16 years (range 1 year-21 years). The 10-year OS rate, 80.6%, tended to vary by patient age: 100% for those aged birth to 10 years, 69.7% for those aged > 10 years to 15 years, and 79.5% for those aged > 15 years to 20 years (P = .147). Patients with melanomas measuring ≤ 1 mm had a favorable prognosis (10-year OS rate of 97%), whereas survival was lower but similar for patients with melanomas measuring > 1 mm to 2 mm, > 2 mm to 4 mm, and > 4 mm (70%, 78%, and 80%, respectively; P = .0077). Ulceration and lymph node metastasis were found to be correlated with worse survival (P = .022 and P = .017, respectively). The 10-year OS rate was 94.1% for patients with American Joint Committee on Cancer stage I disease, 79.6% for those with stage II disease, and 77.1% for patients with stage III disease (P < .001). CONCLUSIONS Tumor thickness, ulceration, lymph node status, and stage were found to be significant predictors of survival in patients with PM, similar to adult melanoma. There is a trend toward increased survival in children aged ≤ 10 years versus adolescents aged > 10 years. Further analyses are needed to probe for potential biological and behavioral differences in pediatric versus adult melanoma.
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Affiliation(s)
- Bruce J. Averbook
- Department of Surgery, Division of Surgical Oncology, MetroHealth Medical Center, Cleveland, Ohio
- Department of Surgery, Case Western Reserve University, Cleveland, Ohio
| | - Sandra J. Lee
- Department of Biostatistics, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Keith A. Delman
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | | | - Jonathan S. Zager
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Vernon K. Sondak
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Jane L. Messina
- Department of Pathology, Cell Biology and Dermatology, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Dermatology and Pathology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Michael S. Sabel
- Department of Surgery, Division of Surgical Oncology, University of Michigan Medical Center, Ann Arbor, Michigan
| | | | | | | | - Susan M. Swetter
- Department of Dermatology, Stanford University Medical Center and VA Palo Alto Health Care System, Pigmented Cell and Melanoma Program, Stanford Cancer Institute, Palo Alto, California
| | - Sancy A. Leachman
- Melanoma and Cutaneous Oncology Program, Department of Dermatology, Huntsman Cancer Institute, Intermountain Healthcare, Salt Lake City, Utah
| | - Alessandro Testori
- Melanoma and Soft Tissue Sarcoma Division, European Institute of Oncology, Milan, Italy
| | - Clara Curiel-Lewandrowski
- Division of Dermatology, Department of Medicine, Department of Medicine, Pigmented Lesion Clinic and Multidisciplinary Cutaneous Oncology Program, University of Arizona Cancer Center Skin Cancer Institute, Tucson, Arizona
| | - Ronald S. Go
- Center for Cancer and Blood Disorders, Gundersen Health System, La Crosse, Wisconsin
| | - Drazen M. Jukic
- Departments of Dermatology and Pathology, Dermatopathology Fellowship Program, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John M. Kirkwood
- Department of Medicine, Dermatology & Translational Science, University of Pittsburgh School of Medicine, Melanoma and Skin Cancer Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
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