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Sutthatarn P, Davidoff AM, Bahrami A, Richard C, Shalini B, Santiago TC, Shulkin BL, Pappo AS, Abdelhafeez A. Regional lymph node evaluation in pediatric conventional melanoma subtype: a single-center 10-year review. Pediatr Surg Int 2024; 40:68. [PMID: 38441654 PMCID: PMC10914839 DOI: 10.1007/s00383-024-05646-8] [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] [Accepted: 01/28/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE To assess the prognostic and therapeutic significance of sentinel lymph node biopsy (SLNB) and completion lymph node dissection (CLND) in pediatric conventional melanoma (CM), while evaluating potential predictive factors for outcomes. METHODS We conducted a retrospective analysis of medical records spanning 2009-2020, focusing on patients aged 18 or younger with localized cutaneous conventional melanoma. RESULTS Among the 33 patients, SLNB detected metastasis in 57.6% of cases, with 52.6% undergoing CLND. Positive SLN patients had higher relapse risk (HR 5.92; 95% CI 1.27-27.7; P = 0.024) but similar overall survival (HR 3.19; 95% CI 0.31-33.1, P = 0.33). No significant differences in disease-free survival (DFS) and OS were found between patients who underwent CLND and those who did not (HR 1.91; 95% CI 0.49-7.43, P = 0.35, and HR 0.52; 95% CI 0.03-8.32, P = 0.64, respectively). Univariate analysis showed age at diagnosis (P = 0.02) correlated with higher recurrence risk, with a 21% hazard increase per additional year of age. CONCLUSIONS Positive SLN status and age at diagnosis were associated with worse DFS in CM patients. Our study did not find any prognostic or therapeutic value in CLND for pediatric melanoma. Further multicenter trials are needed to confirm our single-institution experience. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Pattamon Sutthatarn
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
- Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, 38105, USA
| | - Armita Bahrami
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Celine Richard
- Department of Otolaryngology, University of Tennessee Health Science Center College of Medicine, Memphis, USA.
- Division of Otolaryngology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA.
| | - Bhatia Shalini
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Teresa C Santiago
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, 38105, United States
| | - Alberto S Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, 38105, United States
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Gow KW, Lautz TB, Malek MM, Cost NG, Newman EA, Dasgupta R, Christison-Lagay ER, Tiao GM, Davidoff AM. Children's Oncology Group's 2023 blueprint for research: Surgery. Pediatr Blood Cancer 2024; 71:e30766. [PMID: 37950538 PMCID: PMC10872730 DOI: 10.1002/pbc.30766] [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: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
Surgery plays a crucial role in the treatment of children with solid malignancies. A well-conducted operation is often essential for cure. Collaboration with the primary care team is important for determining if and when surgery should be performed, and if performed, an operation must be done in accordance with well-established standards. The long-term consequences of surgery also need to be considered. Indications and objectives for a procedure vary. Providing education and developing and analyzing new research protocols that include aims relevant to surgery are key objectives of the Surgery Discipline of the Children's Oncology Group. The critical evaluation of emerging technologies to ensure safe, effective procedures is another key objective. Through research, education, and advancing technologies, the role of the pediatric surgeon in the multidisciplinary care of children with solid malignancies will continue to evolve.
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Affiliation(s)
- Kenneth W. Gow
- Division of General & Thoracic Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Timothy B. Lautz
- Department of Pediatric Surgery, Lurie Children’s Hospital of Chicago, Northwestern University School of Medicine, Chicago, Illinois, USA
| | - Marcus M. Malek
- Division of Pediatric General and Thoracic Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nicholas G. Cost
- Department of Surgery, Division of Urology and the Surgical Oncology Program, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Erika A. Newman
- Department of Surgery, Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Emily R. Christison-Lagay
- Division of Pediatric Surgery, Yale School of Medicine, Yale-New Haven Children’s Hospital, New Haven, Connecticut, USA
| | - Gregory M. Tiao
- Division of Pediatric General and Thoracic Surgery, Cincinnati Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
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De Giorgi V, Magnaterra E, Zuccaro B, Magi S, Magliulo M, Medri M, Mazzoni L, Venturi F, Silvestri F, Tomassini GM, Gola M, Tramontana M, Berti S, Stanganelli I, Stingeni L, Covarelli P. Is Pediatric Melanoma Really That Different from Adult Melanoma? A Multicenter Epidemiological, Clinical and Dermoscopic Study. Cancers (Basel) 2023; 15:cancers15061835. [PMID: 36980721 PMCID: PMC10046848 DOI: 10.3390/cancers15061835] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 02/26/2023] [Accepted: 03/11/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE To improve the diagnostic accuracy and optimal management of pediatric melanomas. METHODS We conducted a retrospective descriptive, multicenter study of the epidemiological, clinical, and dermoscopic characteristics of histopathologically proven melanomas diagnosed in patients less than 18 years old. Data on sociodemographic variables, clinical and dermoscopic characteristics, histopathology, local extension, therapy and follow-up, lymph node staging, and outcome were collected from the databases of three Italian dermatology units. We performed a clinical evaluation of the morphological characteristics of each assessed melanoma, using both classic ABCDE criteria and the modified ABCDE algorithm for pediatric melanoma to evaluate which of the two algorithms best suited our series. RESULTS The study population consisted of 39 patients with a histologically confirmed diagnosis of pediatric melanoma. Comparing classic ABCDE criteria with the modified ABCDE algorithm for pediatric melanomas, the modified pediatric ABCDE algorithm was less sensitive than the conventional criteria. Dermoscopically, the most frequent finding was the presence of irregular streaks/pseudopods (74.4%). When evaluating the total number of different suspicious dermoscopy criteria per lesion, 64.1% of the lesion assessments recognized two dermoscopic characteristics, 20.5% identified three, and 15.4% documented four or more assessments. CONCLUSIONS Contrary to what has always been described in the literature, from a clinical point of view, about 95% of our cases presented in a pigmented and non-amelanotic form, and these data must be underlined in the various prevention campaigns where pediatric melanoma is currently associated with a more frequently amelanotic form. All the pediatric melanomas analyzed presented at least two dermoscopic criteria of melanoma, suggesting that this could be a key for the dermoscopic diagnosis of suspected pediatric melanoma, making it possible to reach an early diagnosis even in this age group.
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Affiliation(s)
- Vincenzo De Giorgi
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Florence, Italy
- Cancer Research "Attilia Pofferi" Foundation, 51100 Pistoia, Italy
| | - Elisabetta Magnaterra
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Biancamaria Zuccaro
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Serena Magi
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) IRCCS, 47014 Meldola, Italy
| | - Manfredi Magliulo
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Matelda Medri
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) IRCCS, 47014 Meldola, Italy
| | - Laura Mazzoni
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) IRCCS, 47014 Meldola, Italy
| | - Federico Venturi
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Flavia Silvestri
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Gian Marco Tomassini
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy
| | - Massimo Gola
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Marta Tramontana
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy
| | - Samantha Berti
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) IRCCS, 47014 Meldola, Italy
- Dermatology Unit, Department Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy
| | - Piero Covarelli
- Surgical Oncology Section, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy
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Rousi EK, Kallionpää RA, Kallionpää RE, Juteau SM, Talve LAI, Hernberg MM, Vihinen PP, Kähäri VM, Koskivuo IO. Increased incidence of melanoma in children and adolescents in Finland in 1990-2014: nationwide re-evaluation of histopathological characteristics. Ann Med 2022; 54:244-252. [PMID: 35037531 PMCID: PMC8765276 DOI: 10.1080/07853890.2022.2026001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Changes in the incidence of melanoma in children and adolescents have been reported in Europe and in the USA in the recent decades. AIMS The aim of this study was to examine the incidence of paediatric and adolescent melanomas in Finland in 1990-2014, and the associated clinical and histopathological characteristics to reveal temporal trends, such as changes in diagnostic sensitivity of Spitzoid melanomas. METHODS Information on 122 patients diagnosed with cutaneous melanoma at 0-19 years of age in Finland in 1990-2014 were retrieved from the Finnish Cancer Registry. 73 primary melanoma archival samples were re-evaluated by two dermatopathologists to allow comparability over time. RESULTS A 5.6% annual increase was observed in the incidence of melanoma among children and adolescents during the study period. Fifty-six tumours were confirmed as malignant melanomas in the re-evaluation. After correction for tumour misclassification in the Cancer Registry, the age-adjusted annual incidence was estimated to have increased from 1.4/1 000 000 in 1990-1994 to 5.8/1 000 000 in 2010-2014. The change in incidence was most prominent among adolescents and in Spitzoid melanoma subtype. Melanomas diagnosed 1990-2002 and 2003-2014 did not differ in terms of their clinicopathological characteristics or prognosis (hazard ratio for melanoma-related death 1.53, 95% CI 0.30 to 7.88). Spitzoid melanomas were diagnosed at a younger age, were of higher stage and had higher Clark level than other melanomas, yet the hazard ratio for death was 0.52 (95% CI 0.10 to 2.58) for Spitzoid versus other melanomas. CONCLUSIONS The incidence of cutaneous melanoma has clearly increased among the young in Finland, especially among adolescents. No evidence for overdiagnosis of Spitzoid melanomas as the underlying cause of the increased incidence was observed.Key messageA nationwide retrospective re-evaluation of the cutaneous melanomas recorded in the Finnish Cancer Registry among patients aged 0-19 years in Finland in 1990-2014 revealed an approximately 4-fold increase in the incidence. The increase in the incidence was most prominent among adolescents and in the Spitzoid melanoma subtype. Our results contrast those reported in other countries, where the incidence of melanoma among adolescents has declined.
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Affiliation(s)
- Emma K Rousi
- Department of Plastic and General Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Roope A Kallionpää
- Institute of Biomedicine, University of Turku, University of Turku, Turku, Finland
| | - Roosa E Kallionpää
- Auria Biobank, Turku University Hospital and University of Turku, Turku, Finland
| | - Susanna M Juteau
- Central Laboratory of Pathology, Helsinki University Hospital, Helsinki, Finland
| | - Lauri A I Talve
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Micaela M Hernberg
- Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Pia P Vihinen
- Tyks Cancer Centre and FICAN West, University of Turku and Turku University Hospital, Turku, Finland
| | - Veli-Matti Kähäri
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland.,FICAN West Cancer Centre Laboratory, University of Turku and Turku University Hospital, Turku, Finland
| | - Ilkka O Koskivuo
- Department of Plastic and General Surgery, Turku University Hospital and University of Turku, Turku, Finland
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Rousi EK, Koskivuo IO, Juteau SM, Talve LAI, Hernberg MM, Vihinen PP, Kähäri VM. Different expression of BRAFV600E, ALK and PD-L1 in melanoma in children and adolescents: a nationwide retrospective study in Finland in 1990-2014. Acta Oncol 2021; 60:165-172. [PMID: 32815748 DOI: 10.1080/0284186x.2020.1806358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pediatric melanoma may have a different biological background and more favorable prognosis compared with melanoma in adults. The aim of this study was to investigate melanoma in children and adolescents in the Finnish population in terms of incidence, clinical course, treatment, prognosis and BRAFV600E-, ALK- and PD-L1-positivity of the primary tumors. MATERIALS AND METHODS Primary tumor samples and clinical records of all patients aged 0-19 years diagnosed with cutaneous melanoma in Finland in 1990-2014 were collected using the Finnish Cancer Registry database, Finnish hospitals and private pathology laboratories. BRAFV600E, ALK and PD-L1 were analyzed from 54 primary tumors and BRAFV600E from six metastasis samples. RESULTS A total of 122 patients diagnosed with cutaneous melanoma were retrieved from the Cancer Registry database. The primary tumor samples of 73 patients were obtained for the review, and 56 cases were included in the study. The incidence of pediatric melanoma increased from 0.02 to 0.1/100 000 during the period 1990-2014. Spitzoid melanoma was the most common subtype (66%). The 10-year cancer-specific survival (CSS) was 88.7% in all patients. The 10-year-CSS did not differ in SLNB-positive or -negative groups. BRAFV600E was positive in 48%, ALK in 9% and PD-L1 in 2% of the tumors. BRAFV600E mutation was associated with 83% of melanoma deaths. CONCLUSIONS Young melanoma patients had more favorable prognosis and a different staining profile for BRAFV600E, ALK, and PD-L1 in primary tumor than reported in adults. SLNB status was not an indicator for survival. BRAFV600E-positive patients have worse prognosis and could benefit from surveillance and treatment similarly to adults.
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Affiliation(s)
- Emma K. Rousi
- Department of Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Ilkka O. Koskivuo
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
| | - Susanna M. Juteau
- Central Laboratory of Pathology, Helsinki University Hospital, Helsinki, Finland
| | | | - Micaela M. Hernberg
- Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Pia P. Vihinen
- Tyks Cancer Centre and FICAN West, University of Turku and Turku University Hospital, Turku, Finland
| | - Veli-Matti Kähäri
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland
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Featherston C, Nardi WS, Tomé FR, Quildrian SD. Role of sentinel lymph node biopsy for cutaneous melanoma in elderly patients: preliminary results in a Latin-American population. Ecancermedicalscience 2021; 15:1167. [PMID: 33680081 PMCID: PMC7929767 DOI: 10.3332/ecancer.2021.1167] [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: 07/24/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction In melanoma, lymph node status constitutes the most important prognostic factor among patients with locoregional disease. It has been postulated that elderly patients present less metastatic involvement in sentinel lymph node (SLN). Our objective was to analyse the results and evolution of patients ≥ 70 years-old with cutaneous melanoma in whom sentinel lymph node biopsy (SLNB) was carried out. Methods Retrospective analysis of 194 patients with primary CM who had a SLNB between 2005 and 2020 was included. Demographic and tumour data, SLN status, recurrence rate, morbidity and evolution were evaluated. Patients were divided into two groups according to age: Group 1 (<70 years old) and Group 2 (≥70 years old). Results One hundred and fifty patients were included in Group 1 and 44 patients in Group 2. Median Breslow thickness was 1.7 mm in Group 1 and of 2 mm in Group 2 (p = 0.015).Forty-seven patients had positive SLNB; 38 (25%) belonged to Group 1 and 9 (20.5%) to Group 2 (p = 0.55). Recurrence was found in 34 patients: 25 belonging to Group 1 and 9 corresponding to Group 2 (p = 0.65). Morbidity was of 4% in Group 1 and 9% in Group 2 (p = 0.23). With an average follow-up of 30.6 months, 5-year overall survival was of 87% in Group 1 and of 63% in Group 2 (p = 0.04). Conclusion Advanced age was not associated with differences regarding positivity of SLN and recurrence but difference in overall survival was observed. According to our results and the low morbidity rate, we consider SLNB should not be omitted in such age group, since it improves staging and gives the possibility to evaluate adjuvant treatment.
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Affiliation(s)
- Carola Featherston
- Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina
| | - Walter Sebastián Nardi
- Sarcoma and Melanoma Unit, Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina
| | - Florencia Rocio Tomé
- Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina
| | - Sergio Damian Quildrian
- Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina.,Sarcoma and Melanoma Unit, Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina
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