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Masoomian B, Dalvin LA, Riazi-Esfahani H, Ghassemi F, Azizkhani M, Mirghorbani M, Khorrami-Nejad M, Sajjadi Z, Kaliki S, Sagoo MS, Al Harby L, Al-Jamal RT, Kivelä TT, Giblin M, Lim LAS, Shields CL. Pediatric ocular melanoma: a collaborative multicenter study and meta-analysis. J AAPOS 2023; 27:316-324. [PMID: 37949393 DOI: 10.1016/j.jaapos.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/30/2023] [Accepted: 08/24/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To investigate clinical manifestations and prognoses in pediatric patients (≤12 years old) with ocular melanoma. METHODS This was a retrospective, multicenter cohort study with individual participant data (IPD) meta-analysis pooling available published cases, and unpublished cases from an international collaboration of seven ocular oncology centers. RESULTS There were 133 eyes of 133 pediatric patients with choroidal or ciliary body (n = 66 [50%]), iris (n = 33 [25%]), conjunctival (n = 26 [19%]), and eyelid (n = 8 [6%]) melanoma. Overall, the mean patient age at presentation was 7 years (median, 8; range, 1-12 years), with 63 males (49%). The mean age by tumor site was 6.50 ± 3.90, 7.44 ± 3.57, 9.12 ± 2.61, and 5.63 ± 2.38 years, for choroid/ciliary body, iris, conjunctiva, and eyelid melanoma, respectively (P = 0.001). Association with ocular melanocytosis was seen in 15%, 11%, 4%, and 0%, respectively (P = 0.01). Frequency of ocular melanoma family history did not vary by tumor site (7%, 17%, 9% and 12%, resp. [P = 0.26]). After mean follow-up of 74, 85, 50, and 105 months (P = 0.65), metastasis was seen in 12%, 9%, 19%, and 13% of choroid/ciliary body, iris, conjunctiva, and eyelid melanoma, respectively. Death was reported in 5%, 3%, 8%, and 0%, respectively, with survival analysis indicating higher mortality in choroidal/ciliary body and conjunctival melanoma patients. CONCLUSIONS Ocular melanoma in the pediatric population is rare, with unique clinical features and outcomes. Iris melanoma accounts for about one-third of pediatric uveal melanoma cases.
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Affiliation(s)
- Babak Masoomian
- Ocular Oncology Service, Farabi Eye Hospital Research Center, Tehran university of medical sciences, Tehran, Iran; Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Hamid Riazi-Esfahani
- Ocular Oncology Service, Farabi Eye Hospital Research Center, Tehran university of medical sciences, Tehran, Iran
| | - Fariba Ghassemi
- Ocular Oncology Service, Farabi Eye Hospital Research Center, Tehran university of medical sciences, Tehran, Iran
| | - Momeneh Azizkhani
- Ocular Oncology Service, Farabi Eye Hospital Research Center, Tehran university of medical sciences, Tehran, Iran
| | - Masoud Mirghorbani
- Ocular Oncology Service, Farabi Eye Hospital Research Center, Tehran university of medical sciences, Tehran, Iran
| | - Masoud Khorrami-Nejad
- Ocular Oncology Service, Farabi Eye Hospital Research Center, Tehran university of medical sciences, Tehran, Iran
| | - Zaynab Sajjadi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Mandeep S Sagoo
- Ocular Oncology Service, St Bartholomew's and Moorfields Eye Hospital, London, United Kingdom and NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Lamis Al Harby
- Ocular Oncology Service, St Bartholomew's and Moorfields Eye Hospital, London, United Kingdom and NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Rana'a T Al-Jamal
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tero T Kivelä
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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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: 8] [Impact Index Per Article: 8.0] [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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Pellegrini C, Raimondi S, Di Nardo L, Ghiorzo P, Menin C, Manganoni MA, Palmieri G, Guida G, Quaglino P, Stanganelli I, Massi D, Pastorino L, Elefanti L, Tosti G, Queirolo P, Leva A, Maurichi A, Rodolfo M, Fargnoli MC. Melanoma in children and adolescents: analysis of susceptibility genes in 123 Italian patients. J Eur Acad Dermatol Venereol 2021; 36:213-221. [PMID: 34664323 DOI: 10.1111/jdv.17735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/02/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND A polygenic inheritance involving high, medium and low penetrance genes has been suggested for melanoma susceptibility in adults, but genetic information is scarce for paediatric patients. OBJECTIVE We aim to analyse the major high and intermediate melanoma risk genes, CDKN2A, CDK4, POT1, MITF and MC1R, in a large multicentre cohort of Italian children and adolescents in order to explore the genetic context of paediatric melanoma and to reveal potential differences in heritability between children and adolescents. METHODS One-hundred-twenty-three patients (<21 years) from nine Italian centres were analysed for the CDKN2A, CDK4, POT1, MITF, and MC1R melanoma predisposing genes. The rate of gene variants was compared between sporadic, familial and multiple melanoma patients and between children and adolescents, and their association with clinico-pathological characteristics was evaluated. RESULTS Most patients carried MC1R variants (67%), while CDKN2A pathogenic variants were found in 9% of the cases, the MITF E318K in 2% of patients and none carried CDK4 or the POT1 S270N pathogenic variant. Sporadic melanoma patients significantly differed from familial and multiple cases for the young age at diagnosis, infrequent red hair colour, low number of nevi, low frequency of CDKN2A pathogenic variants and of the MC1R R160W variant. Melanoma in children (≤12 years) had more frequently spitzoid histotype, were located on the head/neck and upper limbs and had higher Breslow thickness. The MC1R V92M variant was more common in children than in adolescents. CDKN2A common polymorphisms and MC1R variants were associated with a high number of nevi. CONCLUSION Our results confirm the scarce involvement of the major high-risk susceptibility genes in paediatric melanoma and suggest the implication of MC1R gene variants especially in the children population.
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Affiliation(s)
- C Pellegrini
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - S Raimondi
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - L Di Nardo
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,Dermatology, Department of Translational Medicine and Surgery, Catholic University of Rome, Italy
| | - P Ghiorzo
- Genetics of Rare Cancers, IRCCS Ospedale Policlinico San Martino, and Department of Internal Medicine and Medical Specialties, University of Genoa, Italy
| | - C Menin
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - M A Manganoni
- Department of Dermatology, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - G Palmieri
- Unit of Cancer Genetics, Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, Sassari, Italy
| | - G Guida
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'A. Moro', Bari, Italy
| | - P Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Torino, Turin, Italy
| | - I Stanganelli
- Skin Cancer Unit, IRCCS-IRST Scientific Institute of Romagna for the Study and Treatment of Cancer, Meldola and University of Parma, Parma, Italy
| | - D Massi
- Department of Health Sciences, University of Florence, Florence, Italy
| | - L Pastorino
- Genetics of Rare Cancers, IRCCS Ospedale Policlinico San Martino, and Department of Internal Medicine and Medical Specialties, University of Genoa, Italy
| | - L Elefanti
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - G Tosti
- Division of Melanoma, Sarcoma and Rare Cancer, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - P Queirolo
- Division of Melanoma, Sarcoma and Rare Cancer, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - A Leva
- Melanoma and Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Maurichi
- Melanoma and Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Rodolfo
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M C Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Vergani E, Frigerio S, Dugo M, Devecchi A, Feltrin E, De Cecco L, Vallacchi V, Cossa M, Di Guardo L, Manoukian S, Peissel B, Ferrari A, Gallino G, Maurichi A, Rivoltini L, Sensi M, Rodolfo M. Genetic Variants and Somatic Alterations Associated with MITF-E318K Germline Mutation in Melanoma Patients. Genes (Basel) 2021; 12:1440. [PMID: 34573422 PMCID: PMC8469310 DOI: 10.3390/genes12091440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/12/2022] Open
Abstract
The MITF-E318K variant has been implicated in genetic predisposition to cutaneous melanoma. We addressed the occurrence of MITF-E318K and its association with germline status of CDKN2A and MC1R genes in a hospital-based series of 248 melanoma patients including cohorts of multiple, familial, pediatric, sporadic and melanoma associated with other tumors. Seven MITF-E318K carriers were identified, spanning every group except the pediatric patients. Three carriers showed mutated CDKN2A, five displayed MC1R variants, while the sporadic carrier revealed no variants. Germline/tumor whole exome sequencing for this carrier revealed germline variants of unknown significance in ATM and FANCI genes and, in four BRAF-V600E metastases, somatic loss of the MITF wild-type allele, amplification of MITF-E318K and deletion of a 9p21.3 chromosomal region including CDKN2A and MTAP. In silico analysis of tumors from MITF-E318K melanoma carriers in the TCGA Pan-Cancer-Atlas dataset confirmed the association with BRAF mutation and 9p21.3 deletion revealing a common genetic pattern. MTAP was the gene deleted at homozygous level in the highest number of patients. These results support the utility of both germline and tumor genome analysis to define tumor groups providing enhanced information for clinical strategies and highlight the importance of melanoma prevention programs for MITF-E318K patients.
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Affiliation(s)
- Elisabetta Vergani
- Unit of Immunotherapy, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (E.V.); (S.F.); (V.V.); (L.R.)
| | - Simona Frigerio
- Unit of Immunotherapy, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (E.V.); (S.F.); (V.V.); (L.R.)
| | - Matteo Dugo
- Platform of Integrated Biology, Department of Applied Research and Technology Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo 42, 20133 Milan, Italy; (M.D.); (A.D.); (L.D.C.); (M.S.)
| | - Andrea Devecchi
- Platform of Integrated Biology, Department of Applied Research and Technology Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo 42, 20133 Milan, Italy; (M.D.); (A.D.); (L.D.C.); (M.S.)
| | - Erika Feltrin
- CRIBI Biotechnology Center, Via Bassi 58/B, 35131 Padua, Italy;
| | - Loris De Cecco
- Platform of Integrated Biology, Department of Applied Research and Technology Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo 42, 20133 Milan, Italy; (M.D.); (A.D.); (L.D.C.); (M.S.)
| | - Viviana Vallacchi
- Unit of Immunotherapy, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (E.V.); (S.F.); (V.V.); (L.R.)
| | - Mara Cossa
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy;
| | - Lorenza Di Guardo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy;
| | - Siranoush Manoukian
- Unit of Medical Genetics, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (S.M.); (B.P.)
| | - Bernard Peissel
- Unit of Medical Genetics, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (S.M.); (B.P.)
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy;
| | - Gianfrancesco Gallino
- Melanoma and Sarcoma Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (G.G.); (A.M.)
| | - Andrea Maurichi
- Melanoma and Sarcoma Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (G.G.); (A.M.)
| | - Licia Rivoltini
- Unit of Immunotherapy, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (E.V.); (S.F.); (V.V.); (L.R.)
| | - Marialuisa Sensi
- Platform of Integrated Biology, Department of Applied Research and Technology Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo 42, 20133 Milan, Italy; (M.D.); (A.D.); (L.D.C.); (M.S.)
| | - Monica Rodolfo
- Unit of Immunotherapy, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (E.V.); (S.F.); (V.V.); (L.R.)
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5
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Manganelli M, Guida S, Ferretta A, Pellacani G, Porcelli L, Azzariti A, Guida G. Behind the Scene: Exploiting MC1R in Skin Cancer Risk and Prevention. Genes (Basel) 2021; 12:1093. [PMID: 34356109 PMCID: PMC8305013 DOI: 10.3390/genes12071093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023] Open
Abstract
Melanoma and non-melanoma skin cancers (NMSCs) are the most frequent cancers of the skin in white populations. An increased risk in the development of skin cancers has been associated with the combination of several environmental factors (i.e., ultraviolet exposure) and genetic background, including melanocortin-1 receptor (MC1R) status. In the last few years, advances in the diagnosis of skin cancers provided a great impact on clinical practice. Despite these advances, NMSCs are still the most common malignancy in humans and melanoma still shows a rising incidence and a poor prognosis when diagnosed at an advanced stage. Efforts are required to underlie the genetic and clinical heterogeneity of melanoma and NMSCs, leading to an optimization of the management of affected patients. The clinical implications of the impact of germline MC1R variants in melanoma and NMSCs' risk, together with the additional risk conferred by somatic mutations in other peculiar genes, as well as the role of MC1R screening in skin cancers' prevention will be addressed in the current review.
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Affiliation(s)
- Michele Manganelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari-“Aldo Moro”, 70125 Bari, Italy; (M.M.); (A.F.)
- DMMT-Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Stefania Guida
- Department of Surgical-Medical-Dental and Morphological Science with Interest Transplant-Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Anna Ferretta
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari-“Aldo Moro”, 70125 Bari, Italy; (M.M.); (A.F.)
| | - Giovanni Pellacani
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Dermatology Clinic, Sapienza University of Rome, 00161 Rome, Italy;
| | - Letizia Porcelli
- Laboratory of Experimental Pharmacology, IRCCS Istituto Tumori Giovanni Paolo II, 70124 Bari, Italy; (L.P.); (A.A.)
| | - Amalia Azzariti
- Laboratory of Experimental Pharmacology, IRCCS Istituto Tumori Giovanni Paolo II, 70124 Bari, Italy; (L.P.); (A.A.)
| | - Gabriella Guida
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari-“Aldo Moro”, 70125 Bari, Italy; (M.M.); (A.F.)
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6
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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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7
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Kieran MW, Geoerger B, Dunkel IJ, Broniscer A, Hargrave D, Hingorani P, Aerts I, Bertozzi AI, Cohen KJ, Hummel TR, Shen V, Bouffet E, Pratilas CA, Pearson ADJ, Tseng L, Nebot N, Green S, Russo MW, Whitlock JA. A Phase I and Pharmacokinetic Study of Oral Dabrafenib in Children and Adolescent Patients with Recurrent or Refractory BRAF V600 Mutation-Positive Solid Tumors. Clin Cancer Res 2019; 25:7294-7302. [PMID: 31506385 DOI: 10.1158/1078-0432.ccr-17-3572] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/02/2018] [Accepted: 09/05/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE The 2-part, phase I/IIa, open-label study (NCT01677741) sought to determine the safety, tolerability, pharmacokinetics, and preliminary activity of dabrafenib in pediatric patients with advanced BRAF V600-mutated cancers. PATIENTS AND METHODS This phase I dose-finding part treated patients ages 1 to <18 years with BRAF V600 mutation-positive tumors with oral dabrafenib 3 to 5.25 mg/kg/day to determine the RP2D based on safety and drug exposure target. RESULTS Between May 2013 and November 2014, 27 patients [12 male; median age, 9 years (range, 1-17 years)] with BRAF V600-mutant solid tumors recurrent/refractory to treatment (low- or high-grade glioma, Langerhans cell histiocytosis, neuroblastoma, or thyroid cancer) were enrolled. The median treatment duration was 75.6 weeks (range, 5.6-148.7 weeks), with 63% treated for >52 weeks and 52% undergoing treatment at data cutoff date. The most common grade 3/4 adverse events suspected to be related to study drug were maculopapular rash and arthralgia (2 patients each). No dose-limiting toxicities were observed. Pharmacokinetic analyses showed a dose-dependent increase in AUC0-12 and achievement of adult exposure levels at the recommended phase II doses of 5.25 mg/kg/day (age <12 years) and 4.5 mg/kg/day (age ≥12 years) divided into 2 equal doses daily, not exceeding 300 mg daily. CONCLUSIONS In this first clinical trial in pediatric patients with pretreated BRAF V600-mutant tumors, dabrafenib was well tolerated while achieving target exposure levels; the average treatment duration was >1 year with many patients still on treatment. The phase II component is also closed and will be reported separately.
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Affiliation(s)
- Mark W Kieran
- Harvard Medical School, Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Birgit Geoerger
- Department of Childhood and Adolescent Oncology, Gustave Roussy Cancer Center, Université Paris-Saclay, Villejuif, France.
| | - Ira J Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Alberto Broniscer
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Darren Hargrave
- UCL Great Ormond Street Institute of Child Health, Pediatric Oncology Unit, London, United Kingdom
| | - Pooja Hingorani
- Phoenix Children's Hospital, Center for Cancer and Blood Disorders, Phoenix, Arizona
| | - Isabelle Aerts
- Institut Curie, PSL Research University, Oncology Center SIREDO, Paris, France
| | | | - Kenneth J Cohen
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Trent R Hummel
- Cancer and Blood Disorder Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Violet Shen
- Children's Hospital of Orange County, Orange, California
| | - Eric Bouffet
- The Hospital for Sick Children, University of Toronto, Department of Pediatrics, Toronto, Ontario
| | - Christine A Pratilas
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Andrew D J Pearson
- Paediatric Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, and The Institute of Cancer Research, Sutton, United Kingdom
| | - Lillian Tseng
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Noelia Nebot
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Mark W Russo
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - James A Whitlock
- The Hospital for Sick Children, University of Toronto, Department of Pediatrics, Toronto, Ontario
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8
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Abstract
Adolescent and young adult (AYA) patients with cancer have not attained the same improvements in overall survival as either younger children or older adults. One possible reason for this disparity may be that the AYA cancers exhibit unique biologic characteristics, resulting in differences in clinical and treatment resistance behaviors. Our current understanding of the unique biological/genomic characteristics of AYA cancers is limited. However, there has been some progress that has provided clues about the biology of AYA cancers. We here review the latest findings in the area of AYA cancer biology and discuss what is required to advance the field for the more effective treatment of this patient population.
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Pellegrini C, Botta F, Massi D, Martorelli C, Facchetti F, Gandini S, Maisonneuve P, Avril MF, Demenais F, Bressac-de Paillerets B, Hoiom V, Cust AE, Anton-Culver H, Gruber SB, Gallagher RP, Marrett L, Zanetti R, Dwyer T, Thomas NE, Begg CB, Berwick M, Puig S, Potrony M, Nagore E, Ghiorzo P, Menin C, Manganoni AM, Rodolfo M, Brugnara S, Passoni E, Sekulovic LK, Baldini F, Guida G, Stratigos A, Ozdemir F, Ayala F, Fernandez-de-Misa R, Quaglino P, Ribas G, Romanini A, Migliano E, Stanganelli I, Kanetsky PA, Pizzichetta MA, García-Borrón JC, Nan H, Landi MT, Little J, Newton-Bishop J, Sera F, Fargnoli MC, Raimondi S. MC1R variants in childhood and adolescent melanoma: a retrospective pooled analysis of a multicentre cohort. THE LANCET. CHILD & ADOLESCENT HEALTH 2019; 3:332-342. [PMID: 30872112 PMCID: PMC6942319 DOI: 10.1016/s2352-4642(19)30005-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/10/2018] [Accepted: 12/21/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Germline variants in the melanocortin 1 receptor gene (MC1R) might increase the risk of childhood and adolescent melanoma, but a clear conclusion is challenging because of the low number of studies and cases. We assessed the association of MC1R variants with childhood and adolescent melanoma in a large study comparing the prevalence of MC1R variants in child or adolescent patients with melanoma to that in adult patients with melanoma and in healthy adult controls. METHODS In this retrospective pooled analysis, we used the M-SKIP Project, the Italian Melanoma Intergroup, and other European groups (with participants from Australia, Canada, France, Greece, Italy, the Netherlands, Serbia, Spain, Sweden, Turkey, and the USA) to assemble an international multicentre cohort. We gathered phenotypic and genetic data from children or adolescents diagnosed with sporadic single-primary cutaneous melanoma at age 20 years or younger, adult patients with sporadic single-primary cutaneous melanoma diagnosed at age 35 years or older, and healthy adult individuals as controls. We calculated odds ratios (ORs) for childhood and adolescent melanoma associated with MC1R variants by multivariable logistic regression. Subgroup analysis was done for children aged 18 or younger and 14 years or younger. FINDINGS We analysed data from 233 young patients, 932 adult patients, and 932 healthy adult controls. Children and adolescents had higher odds of carrying MC1R r variants than did adult patients (OR 1·54, 95% CI 1·02-2·33), including when analysis was restricted to patients aged 18 years or younger (1·80, 1·06-3·07). All investigated variants, except Arg160Trp, tended, to varying degrees, to have higher frequencies in young patients than in adult patients, with significantly higher frequencies found for Val60Leu (OR 1·60, 95% CI 1·05-2·44; p=0·04) and Asp294His (2·15, 1·05-4·40; p=0·04). Compared with those of healthy controls, young patients with melanoma had significantly higher frequencies of any MC1R variants. INTERPRETATION Our pooled analysis of MC1R genetic data of young patients with melanoma showed that MC1R r variants were more prevalent in childhood and adolescent melanoma than in adult melanoma, especially in patients aged 18 years or younger. Our findings support the role of MC1R in childhood and adolescent melanoma susceptibility, with a potential clinical relevance for developing early melanoma detection and preventive strategies. FUNDING SPD-Pilot/Project-Award-2015; AIRC-MFAG-11831.
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Affiliation(s)
- Cristina Pellegrini
- Department of Dermatology and Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca Botta
- Division of Epidemiology and Biostatistics, European Institute of Oncology IRCCS, Milan, Italy; Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Daniela Massi
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Claudia Martorelli
- Department of Dermatology and Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Fabio Facchetti
- Pathology Section, Department of Molecular and Translational Medicine, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Sara Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology IRCCS, Milan, Italy
| | - Marie-Françoise Avril
- APHP, Dermatology Department, Hôpital Cochin and Paris Descartes University, Paris, France
| | - Florence Demenais
- Genetic Variation and Human Diseases Unit (UMR-946), Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | | | - Veronica Hoiom
- Department of Oncology and Pathology, Cancer Centre, Karolinska Institutet, Stockholm, Sweden
| | - Anne E Cust
- Sydney School of Public Health and Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California, Irvine, CA, USA
| | - Stephen B Gruber
- USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Richard P Gallagher
- British Columbia Cancer and Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | | | - Roberto Zanetti
- Piedmont Cancer Registry, Centre for Epidemiology and Prevention in Oncology in Piedmont, Turin, Italy
| | - Terence Dwyer
- George Institute for Global Health, Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - Nancy E Thomas
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Colin B Begg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marianne Berwick
- Department of Internal Medicine, University of New Mexico Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital Clinic Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, and CIBER de Enfermedades Raras, Barcelona, Spain
| | - Miriam Potrony
- Melanoma Unit, Dermatology Department, Hospital Clinic Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, and CIBER de Enfermedades Raras, Barcelona, Spain
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - Paola Ghiorzo
- Department of Internal Medicine and Medical Specialties, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Menin
- Diagnostic Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | | | - Monica Rodolfo
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Emanuela Passoni
- Department of Pathophysiology and Transplantation, University of Milan, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Federica Baldini
- Division of Melanoma, Sarcoma and Rare Cancer, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Guida
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Alexandros Stratigos
- 1st Department of Dermatology, Andreas Sygros Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Fezal Ozdemir
- Department of Dermatology, Faculty of Medicine, University of Ege, Izmir, Turkey
| | - Fabrizio Ayala
- Melanoma Unit, Cancer Immunotherapy and Innovative Therapies, IRCCS Istituto Nazionale dei Tumori, Fondazione G Pascale, Napoli, Italia
| | - Ricardo Fernandez-de-Misa
- Dermatology Service, University Hospital Nuestra Senora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Torino, Turin, Italy
| | - Gloria Ribas
- Department of Medical Oncology and Haematology, Fundación Investigación Clínico de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
| | - Antonella Romanini
- US Ambulatori Melanomi, Sarcomi e Tumori Rari, UO Oncologia Medica 1, Azienda Ospedaliero-Universitaria Santa Chiara, Pisa, Italy
| | - Emilia Migliano
- Plastic Surgery, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, IRCCS Scientific Institute of Romagna for the Study and Treatment of Cancer and University of Parma, Meldola, Italy
| | - Peter A Kanetsky
- Department of Cancer Epidemiology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Jose Carlos García-Borrón
- Department of Biochemistry, Molecular Biology, and Immunology, University of Murcia and IMIB-Arrixaca, Murcia, Spain
| | - Hongmei Nan
- Department of Epidemiology, Richard M Fairbanks School of Public Health, Melvin & Bren Simon Cancer Center, Indiana University, Indianapolis, IN, USA
| | - Maria Teresa Landi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Julia Newton-Bishop
- Section of Epidemiology and Biostatistics, Institute of Medical Research at St James', University of Leeds, Leeds, UK
| | - Francesco Sera
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Concetta Fargnoli
- Department of Dermatology and Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Sara Raimondi
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology IRCCS, Milan, Italy.
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10
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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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11
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Brecht IB, De Paoli A, Bisogno G, Orbach D, Schneider DT, Leiter U, Offenmueller S, Cecchetto G, Godzinski J, Bien E, Stachowicz-Stencel T, Ben-Ami T, Chiaravalli S, Maurichi A, De Salvo GL, Sorbara S, Bodemer C, Garbe C, Reguerre Y, Ferrari A. Pediatric patients with cutaneous melanoma: A European study. Pediatr Blood Cancer 2018; 65:e26974. [PMID: 29350487 DOI: 10.1002/pbc.26974] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/10/2017] [Accepted: 12/15/2017] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Cutaneous melanoma is rare in childhood and published studies have mainly been retrospective single-institution series or small case series. Given the absence of clinical protocols dedicated to pediatric melanoma, the treatment approach is generally extrapolated from the ones applied to adults. METHODS Coordinated by the European Cooperative Study Group for Pediatric Rare Tumors (EXPeRT), this study collected patients prospectively registered between 2002 and 2012 under national cooperative projects dedicated to rare pediatric tumors in Italy, Poland, Germany, and France. Additional cases were collected from dermatology registries in Germany and Israel. RESULTS A total of 219 patients aged 0-18 years (median 14.4) were included in the analysis. Sentinel lymph node biopsy was performed in 112 patients (76% of those with Breslow thickness > 0.75 mm) and was positive in 37.5%. Systemic therapy was used in 33 cases. In stage III cases, survival rates were similar for patients who received (23 cases) or not (21 cases) adjuvant therapy. For the whole series, 3-year overall and disease-free survival rates were 91.4% and 84.0%, respectively (median follow-up 41.8 months). Tumor site, tumor stage, and ulceration influenced survival rates. Patients treated by pediatric oncologists (n = 140) were more likely to have advanced disease than those treated by dermatologists (n = 79). DISCUSSION This study would suggest that the clinical history of melanoma in children and adolescents might resemble that of adult counterpart. Cooperative efforts are needed to make new drugs more readily available to pediatric patients to increase the outcome of patient with advanced disease.
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Affiliation(s)
- Ines B Brecht
- Pediatric Hematology and Oncology, University of T, bingen, Tübingen, Germany
| | - Angela De Paoli
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - Gianni Bisogno
- Hematology-Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with cancer), Institut Curie, Paris, France
| | | | - Ulrike Leiter
- Center for Dermato-Oncology, Department of Dermatology, Central Malignant Melanoma Registry of the German Dermatological Society, University Hospital Tübingen, Tübingen, Germany
| | - Sonja Offenmueller
- Pediatric Hematology and Oncology, University Children's Hospital Erlangen, Erlangen, Germany
| | - Giovanni Cecchetto
- Pediatric Surgery, Department of Pediatrics, Padova University Hospital, Padova, Italy
| | - Jan Godzinski
- Department of Pediatric Surgery, Marciniak Hospital, Wroclaw, Poland
| | - Ewa Bien
- Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland
| | | | - Tal Ben-Ami
- Department of Pediatrics, Hadassah University Medical Center, Jerusalem, Israel
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Andrea Maurichi
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - Silvia Sorbara
- Hematology-Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Christine Bodemer
- Pediatric Dermatology Department, Necker Hospital Assistance Publique, Paris, France
| | - Claus Garbe
- Center for Dermato-Oncology, Department of Dermatology, Central Malignant Melanoma Registry of the German Dermatological Society, University Hospital Tübingen, Tübingen, Germany
| | - Yves Reguerre
- Pediatric Hematology-Oncology Department, Centre Hospitalier Universitaire, Saint Denis de La Réunion, France
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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12
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Toscano de Mendonça UB, Cernea CR, Matos LL, Monteiro de Araujo Lima RR. Analysis of KIT gene mutations in patients with melanoma of the head and neck mucosa: a retrospective clinical report. Oncotarget 2018; 9:22886-22894. [PMID: 29796159 PMCID: PMC5955421 DOI: 10.18632/oncotarget.25094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/22/2018] [Indexed: 11/25/2022] Open
Abstract
Unlike their cutaneous counterparts, head and neck mucosal malignant melanomas (HNMM) are more aggressive, and their prognostic markers have not been fully elucidated. This study, comprising 28 patients with HNMM, aimed to establish the relationship between different mutations and outcome, define the incidence of KIT mutations in HNMM, and identify the correlation among therapeutic options, histopathological findings, demographic data, and clinical response. Clinical analysis included patient characteristics, staging, primary and palliative treatments, and disease-free survival and overall survival (OS). Progression-free survival and OS were analyzed. Paraffin blocks were selected following histologic analyses, enabling DNA extraction. PCR amplification of exons 9, 11, 13, and 17, with different DNA concentrations, was performed. Patients were predominantly females (57%) and aged 27–85 years. All patients underwent surgery; 17 received adjuvant radiotherapy, and recurrences occurred in 82% patients. Oncologic mutations in KIT were found in 7 of 7 tumors, 3 in exon 9, 3 in exon 11, and 1 in exon 13. Predictive factors for recurrence were mitotic rate, vascular invasion, and perineural spread. There were no significant differences in DFS and OS according to KIT mutation. Our study results suggest that some patients might benefit from appropriate targeted therapy with kinase inhibitors.
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Affiliation(s)
| | - Claudio Roberto Cernea
- Department of Head and Neck Surgery, School of Medicine, University of São Paulo, Sao Paulo-SP, Brazil
| | - Leandro Luongo Matos
- Department of Head and Neck Surgery, School of Medicine, University of São Paulo, Sao Paulo-SP, Brazil
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13
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Wu X, Zhao Z, Ding Y, Xiang F, Kang X, Pu X. Differential expression of microRNAs in the normal skin of the Han and Uyghur populations in Xinjiang Province. Medicine (Baltimore) 2018; 97:e9928. [PMID: 29443776 PMCID: PMC5839858 DOI: 10.1097/md.0000000000009928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
In this study, we investigated the expression of microRNAs (miRNAs) in the skin samples from the Han and Uyghur populations in Xinjiang, China. The miRNA levels of the normal skin samples from 10 individuals of Uyghur or Han were tested by microarray and the expression differentiations were compared. Among the 3100 probes for microarray, a total of 247 miRNAs were differentially expressed in the Han versus Uyghur population, including 76 upregulated miRNAs and 171 downregulated miRNAs. The most significantly upregulated miRNAs were miR-141-3p, miR-1915-5p, kshv-miR-K12-2-5p, and miR-222-3p. And the most significantly downregulated miRNAs included miR-1207-3p and miR-625-3p. We have confirmed the upregulation of miR-141-3p and miR-1915-5p by qRT-PCR. There were no statistical correlations in the expression of miR-141-3p or miR-1915-5p with the age or gender within each group. Interestingly, the differentially expressed miRNAs were enriched in some cancer-related pathways, such as p53, mitogen-activated protein kinase, and WNT signal pathways. Collectively, these dysregulated expressions of the miRNAs may provide a better understanding of the differences in the incidence and mortality of skin-related carcinoma between the Uyghur and Han populations in Xinjiang.
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Affiliation(s)
- Xiujuan Wu
- Department of Dermatology and Venereology
| | - Zongfeng Zhao
- Clinical Medical Research Center, People's Hospital of Xinjiang, Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Yuan Ding
- Department of Dermatology and Venereology
| | - Fang Xiang
- Department of Dermatology and Venereology
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14
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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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15
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Tricoli JV, Bleyer A, Anninga J, Barr R. The Biology of AYA Cancers. CANCER IN ADOLESCENTS AND YOUNG ADULTS 2017. [DOI: 10.1007/978-3-319-33679-4_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Rizzo D, Ruggiero A, Amato M, Maurizi P, Riccardi R. BRAF and MEK inhibitors in pediatric glioma: new therapeutic strategies, new toxicities. Expert Opin Drug Metab Toxicol 2016; 12:1397-1405. [PMID: 27494648 DOI: 10.1080/17425255.2016.1214710] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION BRAF mutation was initially reported in metastatic melanomas, and more recently in a variety of human cancers. BRAF acts as a down-stream effector of growth factor signaling leading to cell cycle progression, proliferation and survival. Development of selective inhibitors of BRAF has improved the survival of patients with melanoma and offers potential new therapeutic strategy in children with BRAF-mutant glioma. Areas covered: Mechanisms of resistance to BRAF inhibitors have recently been described as due to the paradoxical activation of the MAPK pathway. Combination therapy with BRAF and MEK inhibition has proved capable of overcoming the resistance with effective results in patients with melanoma. Prospective studies in pediatric glioma are warranted. Combination therapy has a different toxicity profile compared to BRAF inhibitor alone. Herein we review the state-of-the-art of toxicities associated with these agents, with a special focus on children. Expert opinion: Some toxicities appear more specific to adults, due to a combination of factors, such as patient age and predisposing risk factors. Moreover, it is recommended that the co-administration of BRAF inhibitors and drugs metabolized by the cytochrome P450 system in the liver be avoided, as this can lead to significant complications secondary to pharmacological interactions.
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Affiliation(s)
- Daniela Rizzo
- a Division of Pediatric Oncology , Catholic University of Rome , Rome , Italy
| | - Antonio Ruggiero
- a Division of Pediatric Oncology , Catholic University of Rome , Rome , Italy
| | - Maria Amato
- a Division of Pediatric Oncology , Catholic University of Rome , Rome , Italy
| | - Palma Maurizi
- a Division of Pediatric Oncology , Catholic University of Rome , Rome , Italy
| | - Riccardo Riccardi
- a Division of Pediatric Oncology , Catholic University of Rome , Rome , Italy
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Abstract
Malignant melanoma can affect patients of any age. It has been well documented that the overall incidence of melanoma has increased in the past several decades, and this increase extends to the pediatric population (both preadolescent and, to a greater extent, adolescent children). Melanoma in adolescents, commonly defined as patients 11 to 19 years of age, behaves similarly to melanoma in adults; however, there are a number of distinct differences in the presentation and prognosis of melanoma in the preadolescent population. Though our treatment options for melanoma are increasing with the advent of novel drugs and clinical trials, the rarity of pediatric melanomas often excludes this population from clinical studies. The treatment options for the pediatric patient are predominantly based on adult clinical trials. Awareness of the differences in clinical presentation, as well as management of melanoma in younger patients compared with their adult counterparts, is crucial to guarantee prompt and appropriate care.
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18
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Navid F, Herzog CE, Sandoval J, Daryani VM, Stewart CF, Gattuso J, Mandrell B, Phipps S, Chemaitilly W, Sykes A, Davidoff AM, Shulkin BL, Bahrami A, Furman WL, Mao S, Wu J, Schiff D, Rao B, Pappo A. Feasibility of Pegylated Interferon in Children and Young Adults With Resected High-Risk Melanoma. Pediatr Blood Cancer 2016; 63:1207-13. [PMID: 27038395 PMCID: PMC4877209 DOI: 10.1002/pbc.25983] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/27/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pegylated interferon α-2b (IFN α-2b) improves disease-free survival in adults with resected stage III melanoma. We conducted a study to determine the feasibility and safety of incorporating pegylated IFN α-2b as adjuvant therapy in the treatment of children and adolescents with high-risk melanoma. Pharmacokinetic studies of IFN α-2b and neuropsychological and quality of life (OL) assessments were performed. PATIENT AND METHODS Eligible patients with resected American Joint Committee on Cancer Stage IIC, IIIA, and IIIB cutaneous melanoma received nonpegylated IFN α-2b 20 million units/m(2) /day intravenously 5 days per week for 4 weeks (induction) followed by pegylated IFN α-2b 1 μg/kg/dose weekly subcutaneously (SQ) for 48 weeks (maintenance). RESULTS Twenty-three patients (15 females, median age 10 years) were enrolled. All patients completed induction therapy; five patients did not complete maintenance therapy either because of recurrent disease (n = 2) or toxicity (n = 3). The most common grade 3 and 4 toxicities of pegylated IFN α-2b were neutropenia (35%) and elevated liver transaminases (17%). The median nonpegylated IFN α-2b AUC0-∞ (5,026 pcg⋅hr/ml) was similar to adults. The median pegylated IFN α-2b exposure (48,480 pcg⋅hr/ml) was greater than the cumulative weekly exposure for nonpegylated IFN α-2b administered SQ three times per week (TIW). Validated measures demonstrated an improvement in QOL scores and no decline in psychological functioning over the course of therapy. CONCLUSIONS Pegylated IFN α-2b 1 μg/kg/dose SQ weekly as maintenance therapy in children and adolescents with high-risk melanoma is feasible with tolerable toxicity and appears to yield higher exposures than nonpegylated IFN α-2b administered SQ TIW.
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Affiliation(s)
- Fariba Navid
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | | | - John Sandoval
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Vinay M. Daryani
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Clinton F. Stewart
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Jami Gattuso
- Department of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN
| | - Belinda Mandrell
- Department of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Wassim Chemaitilly
- Department of Pediatric Medicine-Division of Endocrinology, St. Jude Children's Research Hospital, Memphis, TN
| | - April Sykes
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Barry L. Shulkin
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Armita Bahrami
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Wayne L. Furman
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Shenghua Mao
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Jianrong Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Deborah Schiff
- Department of Pediatrics, University of California-San Diego, La Jolla, CA
| | - Bhaskar Rao
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Alberto Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN,Corresponding author: Alberto Pappo, MD, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis TN 38105, Telephone: (901) 595-2322, FAX: (901) 521-9005,
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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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Tricoli JV, Blair DG, Anders CK, Bleyer WA, Boardman LA, Khan J, Kummar S, Hayes-Lattin B, Hunger SP, Merchant M, Seibel NL, Thurin M, Willman CL. Biologic and clinical characteristics of adolescent and young adult cancers: Acute lymphoblastic leukemia, colorectal cancer, breast cancer, melanoma, and sarcoma. Cancer 2016; 122:1017-28. [PMID: 26849082 DOI: 10.1002/cncr.29871] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 01/20/2023]
Abstract
Adolescent and young adult (AYA) patients with cancer have not attained the same improvements in overall survival as either younger children or older adults. One possible reason for this disparity may be that the AYA cancers exhibit unique biologic characteristics, resulting in differences in clinical and treatment resistance behaviors. This report from the biologic component of the jointly sponsored National Cancer Institute and LiveStrong Foundation workshop entitled "Next Steps in Adolescent and Young Adult Oncology" summarizes the current status of biologic and translational research progress for 5 AYA cancers; colorectal cancer breast cancer, acute lymphoblastic leukemia, melanoma, and sarcoma. Conclusions from this meeting included the need for basic biologic, genomic, and model development for AYA cancers as well as translational research studies to elucidate any fundamental differences between pediatric, AYA, and adult cancers. The biologic questions for future research are whether there are mutational or signaling pathway differences (for example, between adult and AYA colorectal cancer) that can be clinically exploited to develop novel therapies for treating AYA cancers and to develop companion diagnostics.
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Affiliation(s)
- James V Tricoli
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
| | - Donald G Blair
- Division of Cancer Biology, National Cancer Institute, Rockville, Maryland
| | - Carey K Anders
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - W Archie Bleyer
- Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon
| | - Lisa A Boardman
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Javed Khan
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Shivaani Kummar
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
| | - Brandon Hayes-Lattin
- Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon
| | - Stephen P Hunger
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melinda Merchant
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Nita L Seibel
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
| | - Magdalena Thurin
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
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Le Q, Norris D, McClean CA, Mcguiness M, Meani R, Kelly JW, Pan Y. Single institution experience of paediatric melanoma in Victoria, Australia. Australas J Dermatol 2016; 58:117-121. [PMID: 26821217 DOI: 10.1111/ajd.12436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 11/02/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND/OBJECTIVES Paediatric melanoma is an uncommon presentation of melanoma that accounts for 3% of all paediatric cancers. The objective was to describe a series of paediatric melanoma cases presenting to a state-wide tertiary referral service over the past 19 years. METHODS A search of the Victorian Melanoma Service database was performed to identify all patients under the age of 20 years diagnosed with melanoma from 1994 to 2013. Histological, demographic and phenotypical information for each patient was collected. Patients were matched against the Victorian Death Registry to identify those who had died. Fisher's exact test was used to examine associations. Melanoma-specific survival was estimated using the Kaplan-Meier method. RESULTS A total of 65 paediatric melanoma patients were included for analysis, in whom 72.3% of melanomas were diagnosed when they were 16-19 years of age with a mean age at diagnosis of 16 years. The mean Breslow thickness was 1.4 mm. It was greatest (3.4 mm) in the youngest age group (< 12 years of age). Ten patients developed nodal metastatic disease, eight of which progressed to visceral metastatic disease. The 5-year melanoma-specific survival rate was 96.8%. CONCLUSION This is the first descriptive epidemiological study of paediatric melanoma in Victoria. Further large, population-based, multi-institutional studies of paediatric melanoma are warranted to provide a clearer understanding of this group of melanoma patients.
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Affiliation(s)
- Quynh Le
- Victorian Melanoma Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Diana Norris
- Victorian Melanoma Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Catriona A McClean
- Victorian Melanoma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Anatomical Pathology, The Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Myra Mcguiness
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rowena Meani
- Victorian Melanoma Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - John W Kelly
- Victorian Melanoma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Yan Pan
- Victorian Melanoma Service, The Alfred Hospital, Melbourne, Victoria, Australia
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Abstract
Pediatric melanoma is rare and given the diagnostic challenges it presents in this age group, it is difficult to interpret the literature describing its natural history and outcome. Recent genomic analysis demonstrates that conventional melanoma in children and adolescents shares many of the genomic features that have been described in adult melanoma, including BRAF mutations. Thus, this patient group should be given the opportunity to enroll in National Cancer Institute and pharmaceutically sponsored trials that incorporate novel targeted agents.
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Affiliation(s)
- Alberto S Pappo
- From the Solid Tumor Division, St. Jude Children's Research Hospital, Memphis, TN
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Stark D, Bielack S, Brugieres L, Dirksen U, Duarte X, Dunn S, Erdelyi D, Grew T, Hjorth L, Jazbec J, Kabickova E, Konsoulova A, Kowalczyk J, Lassaletta A, Laurence V, Lewis I, Monrabal A, Morgan S, Mountzios G, Olsen P, Renard M, Saeter G, van der Graaf W, Ferrari A. Teenagers and young adults with cancer in Europe: from national programmes to a European integrated coordinated project. Eur J Cancer Care (Engl) 2015; 25:419-27. [DOI: 10.1111/ecc.12365] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 01/28/2023]
Affiliation(s)
- D. Stark
- Leeds Institute of Cancer and Pathology; Leeds Institute of Oncology and St James's University Hospital; University of Leeds; Leeds UK
| | - S. Bielack
- Klinikum Stuttgart; Center for Pediatric and Adolescent Medicine; Pediatrics 5 (Oncology, Hematology, Immunology); Olgahospital; Stuttgart Germany
| | - L. Brugieres
- Department of Children and Adolescents Oncology; Institut Gustave Roussy; Villejuif France
| | - U. Dirksen
- University Hospital Muenster; Department of Pediatric Hematology and Oncology; Westfalian Wilhelms University; Muenster Germany
- Hospital Infantil Universitario Niño Jesús; Madrid Spain
| | - X. Duarte
- Instituto Português de Oncologia de Lisboa; Lisbon Portugal
| | - S. Dunn
- Teenage Cancer Trust; London UK
| | | | - T. Grew
- Oxford University Clinical Academic Graduate School; Oxford UK
| | - L. Hjorth
- Department of Pediatrics; Skåne University Hospital; Clinical Sciences Lund University; Lund Sweden
| | - J. Jazbec
- Division of Pediatrics; Unit of Hematooncology; University Medical Centre Ljubljana; Ljubljana Slovenia
| | | | | | - J.R. Kowalczyk
- Children's University Hospital; Skubiszewski Medical University of Lublin; Lublin Poland
| | - A. Lassaletta
- Hospital Infantil Universitario Niño Jesús; Madrid Spain
| | - V. Laurence
- Department of Medical and Pediatric Oncology; Institut Curie; Paris France
| | - I. Lewis
- Alder Hey Children's NHS Foundation Trust; Liverpool
| | - A. Monrabal
- Spanish Association of Adolescents and Young Adult with Cancer; London
| | - S. Morgan
- Teenage Cancer Trust Unit; St James's University Hospital; Leeds UK
| | - G. Mountzios
- University of Athens School of Medicine; Athens Greece
| | - P.R. Olsen
- Department of Oncology; Aarhus University Hospital; Aarhus C Denmark
| | - M. Renard
- Department of Pediatric Hemato-Oncology; University Hospitals Leuven; Leuven Belgium
| | - G. Saeter
- Institute for Cancer Research; Oslo University Hospital; Oslo Norway
| | - W.T. van der Graaf
- Department of Medical Oncology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - A. Ferrari
- Pediatric Oncology Unit; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
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Kim SY, Kim SN, Hahn HJ, Lee YW, Choe YB, Ahn KJ. Metaanalysis of BRAF mutations and clinicopathologic characteristics in primary melanoma. J Am Acad Dermatol 2015; 72:1036-46.e2. [PMID: 25819940 DOI: 10.1016/j.jaad.2015.02.1113] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 02/08/2015] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND BRAF mutations occur in some melanomas. We hypothesized that BRAF mutation rates may differ in melanomas found in Asian compared to white populations. OBJECTIVE We performed a metaanalysis of BRAF mutations and their associations with the clinicopathologic characteristics of primary melanoma (PM), with a subgroup analysis to compare Asian and white patients with PM. METHODS The PubMed, EMBASE, and Cochrane databases were searched up to November 2013. The incidence rates and odds ratios (ORs) of BRAF mutations were calculated using a fixed or random effects model. RESULTS BRAF mutation was associated with younger age (OR = 1.734; P < .001), trunk location (OR = 2.272; P < .001), non-chronically sun damaged skin (OR = 2.833; P < .001), superficial spreading melanoma (OR = 2.081; P < .001), and advanced melanoma stage (OR = 1.551; P = .003). The incidence of BRAF mutations in Asian patients with PM was half that of white patients with PM, but it was linked to the same clinicopathologic characteristics. LIMITATIONS Only a small number of studies have been conducted on Asian patients with PMs. CONCLUSIONS The BRAF mutation in PM was associated with age, anatomic site based on ultraviolet radiation exposure, histologic subtype, and advanced stage of melanoma. The clinicopathologic associations with BRAF mutations were similar in Asian and white patients with PM.
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Affiliation(s)
- Soo Young Kim
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Soo Nyung Kim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea
| | - Hyung Jin Hahn
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Yang Won Lee
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea; Research Institute of Medical Science, Konkuk University, Seoul, Korea.
| | - Yong Beom Choe
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea; Research Institute of Medical Science, Konkuk University, Seoul, Korea
| | - Kyu Joong Ahn
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea; Research Institute of Medical Science, Konkuk University, Seoul, Korea
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Hirsch S, Marshall LV, Carceller Lechon F, Pearson ADJ, Moreno L. Targeted approaches to childhood cancer: progress in drug discovery and development. Expert Opin Drug Discov 2015; 10:483-95. [DOI: 10.1517/17460441.2015.1025745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Frigerio S, Disciglio V, Manoukian S, Peissel B, Della Torre G, Maurichi A, Collini P, Pasini B, Gotti G, Ferrari A, Rivoltini L, Massimino M, Rodolfo M. A large de novo 9p21.3 deletion in a girl affected by astrocytoma and multiple melanoma. BMC MEDICAL GENETICS 2014; 15:59. [PMID: 24884915 PMCID: PMC4036080 DOI: 10.1186/1471-2350-15-59] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 05/05/2014] [Indexed: 11/10/2022]
Abstract
Background Association of melanoma, neural system tumors and germ line mutations at the 9p21 region in the CDKN2A, CDKN2B and CDKN2BAS genes has been reported in a small number of families worldwide and described as a discrete syndrome in melanoma families registered as a rare disease, the melanoma–astrocytoma syndrome. Case presentation We here studied two young patients developing melanoma after radiotherapy for astrocytoma, both reporting lack of family history for melanoma or neural system tumors at genetic counselling. Patient A is a girl treated for anaplastic astrocytoma at 10 years and for multiple melanomas on the scalp associated to dysplastic nevi two years later. Her monozygotic twin sister carried dysplastic nevi and a slow growing, untreated cerebral lesion. Direct sequencing analysis showed no alterations in melanoma susceptibility genes including CDKN2A, CDK4, MC1R and MITF or in TP53. By microsatellite analysis, multiplex ligation-dependent probe amplification, and array comparative genomic hybridization a deletion including the CDKN2A, CDKN2B and CDKN2BAS gene cluster was detected in both twin sisters, encompassing a large region at 9p21.3 and occurring de novo after the loss of one paternal allele. Patient B is a boy of 7 years when treated for astrocytoma then developing melanoma associated to congenital nevi on the head 10 years later: sequencing and multiplex ligation-dependent probe amplification revealed a normal profile of the CDKN2A/CDKN2B/CDKN2BAS region. Array comparative genomic hybridization confirmed the absence of deletions at 9p21.3 and failed to reveal known pathogenic copy number variations. Conclusions By comparison with the other germ line deletions at the CDKN2A, CDKN2B and CDKN2BAS gene cluster reported in melanoma susceptible families, the deletion detected in the two sisters is peculiar for its de novo origin and for its extension, as it represents the largest constitutive deletion at 9p21.3 region identified so far. In addition, the two studied cases add to other evidence indicating association of melanoma with exposure to ionizing radiation and with second neoplasm after childhood cancer. Melanoma should be considered in the monitoring of pigmented lesions in young cancer patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Monica Rodolfo
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milan 20133, Italy.
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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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Bassoli S, Maurichi A, Rodolfo M, Casari A, Frigerio S, Pupelli G, Farnetani F, Pelosi G, Santinami M, Pellacani G. CDKN2A and MC1R variants influence dermoscopic and confocal features of benign melanocytic lesions in multiple melanoma patients. Exp Dermatol 2014; 22:411-6. [PMID: 23711066 DOI: 10.1111/exd.12168] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2013] [Indexed: 12/20/2022]
Abstract
Non-invasive diagnostic tools are effective in the histomorphological study of melanocytic lesions. The role of melanoma susceptibility genes on melanocytic nevi histopathological features is not clear. The current study aimed to correlate genetic alterations and histomorphological features of melanocytic nevi. Clinical, dermoscopic and confocal features of 34 multiple melanoma patients and 34 controls were compared. Among patients with melanoma, carriers of CDKN2A mutations and/or MC1R variants, and wild-type genes were also compared. In patients with melanoma, a lighter phototype (P = 0.051), a higher number of nevi (P < 0.01) and clinically atypical nevi (P < 0.01) were observed. At dermoscopy, these nevi showed a complex pattern (P = 0.011), atypical network (P = 0.018) and irregular pigmentation (P = 0.037); at confocal, an irregular meshwork pattern (P = 0.026) with atypical nests (P = 0.016) and an inflammatory infiltrate (P = 0.048) were observed. Among patients with melanoma genetically tested, CDKN2A G101W mutation carriers were more frequently younger (P = 0.023), with clinically atypical nevi (P = 0.050), with cytological atypia (P = 0.033) at confocal. G101W mutation and MC1R variants carriers showed hypopigmented nevi (P = 0.002) and, at confocal, roundish cells infiltrating the junction (P = 0.019). These data suggest an influence of CDKN2A mutation and MC1R variants in the development of dysplastic melanocytic lesions. Non-invasive histomorphological evaluation, together with genetic studies, improves melanoma risk identification and early diagnosis, for a patient-tailored management.
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Affiliation(s)
- Sara Bassoli
- Dermatology Department, University of Modena and Reggio Emilia, Modena, Italy.
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Ferrari A, Casanova M, Massimino M, Sultan I. Peculiar features and tailored management of adult cancers occurring in pediatric age. Expert Rev Anticancer Ther 2014; 10:1837-51. [DOI: 10.1586/era.10.105] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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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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Balch CM, Soong SJ, Gershenwald JE, Thompson JF, Coit DG, Atkins MB, Ding S, Cochran AJ, Eggermont AMM, Flaherty KT, Gimotty PA, Johnson TM, Kirkwood JM, Leong SP, McMasters KM, Mihm MC, Morton DL, Ross MI, Sondak VK. Age as a prognostic factor in patients with localized melanoma and regional metastases. Ann Surg Oncol 2013; 20:3961-8. [PMID: 23838920 DOI: 10.1245/s10434-013-3100-9] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND We postulated that the worse prognosis of melanoma with advancing age reflected more aggressive tumor biology and that in younger patients the prognosis would be more favorable. MATERIALS AND METHODS The expanded AJCC melanoma staging database contained 11,088 patients with complete data for analysis, including mitotic rate. RESULTS With increasing age by decade, primary melanomas were thicker, exhibited higher mitotic rates, and were more likely to be ulcerated. In a multivariate analysis of patients with localized melanoma, thickness and ulceration were highly significant predictors of outcome at all decades of life (except for patients younger than 20 years). Mitotic rate was significantly predictive in all age groups except patients <20 and >80 years. For patients with stage III melanoma, there were four independent variables associated with patient survival: number of nodal metastases, patient age, ulceration, and mitotic rate. Patients younger than 20 years of age had primary tumors with slightly more aggressive features, a higher incidence of sentinel lymph node metastasis, but, paradoxically, more favorable survival than all other age groups. In contrast, patients >70 years old had primary melanomas with the most aggressive prognostic features, were more likely to be head and neck primaries, and were associated with a higher mortality rate than the other age groups. Surprisingly, however, these patients had a lower rate of sentinel lymph node metastasis per T stage. Among patients between the two age extremes, clinicopathologic features and survival tended to be more homogeneous. CONCLUSIONS Melanomas in patients at the extremes of age have a distinct natural history.
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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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The Adolescent and Young Adult With Cancer: State of the Art—Epithelial Cancer. Curr Oncol Rep 2013; 15:287-95. [DOI: 10.1007/s11912-013-0322-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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36
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[Melanoma in children: diagnosis and treatment specificities]. Bull Cancer 2012; 99:881-8. [PMID: 22961389 DOI: 10.1684/bdc.2012.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Skin melanoma is an extremely rare disease at pediatric age and its incidence increases with age. Links with predisposition syndrome exists (giant congenital naevus, xeroderma pigmentosum). Diagnosis is often difficult and distinction between benign or malignant lesion is sometime impossible (Spitzoid naevus, melanocytic neoplasms) leading to the diagnosis of "melanocytic tumor of uncertain malignant potential" (MELTUMP). Atypical features (amelanotic or raised lesions, atypical histotype) are frequent leading to delay in treatment. Diagnosis and treatment require expertise for pathologists and dermatologists pediatricians. Invasive melanomas are of poor prognosis despite recent progress in adult treatment. Early and rigorous treatment of suspect skin lesions is necessary.
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Turri-Zanoni M, Medicina D, Lombardi D, Ungari M, Balzarini P, Rossini C, Pellegrini W, Battaglia P, Capella C, Castelnuovo P, Palmedo G, Facchetti F, Kutzner H, Nicolai P, Vermi W. Sinonasal mucosal melanoma: Molecular profile and therapeutic implications from a series of 32 cases. Head Neck 2012; 35:1066-77. [DOI: 10.1002/hed.23079] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2012] [Indexed: 12/12/2022] Open
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Huynh KT, Takei Y, Kuo C, Scolyer RA, Murali R, Chong K, Takeshima L, Sim MS, Morton DL, Turner RR, Thompson JF, Hoon DSB. Aberrant hypermethylation in primary tumours and sentinel lymph node metastases in paediatric patients with cutaneous melanoma. Br J Dermatol 2012; 166:1319-26. [PMID: 22293026 DOI: 10.1111/j.1365-2133.2012.10867.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Debate on how to manage paediatric patients with cutaneous melanoma continues, particularly in those with sentinel lymph node (SLN) metastases who are at higher risk of poor outcomes. Management is often based on adult algorithms, although differences in clinical outcomes between paediatric and adult patients suggest that melanoma in paediatric patients differs biologically. Yet, there are no molecular prognostic studies identifying these differences. OBJECTIVES We investigated the epigenetic (methylation) regulation of several tumour-related genes (TRGs) known to be significant in adult melanoma progression in histopathology(+) SLN metastases (n = 17) and primary tumours (n = 20) of paediatric patients with melanoma to determine their clinical relevance. METHODS Paediatric patients (n = 37; ≤ 21 years at diagnosis) with American Joint Committee on Cancer stage I-III cutaneous melanoma were analysed. Gene promoter methylation of the TRGs RASSF1A, RARβ2, WIF1 and APC was evaluated. RESULTS Hypermethylation of RASSF1A, RARβ2, WIF1 and APC was found in 29% (5/17), 25% (4/16), 25% (4/16) and 19% (3/16) of histopathology(+) SLNs, respectively. When matched to adult cutaneous melanomas by Breslow thickness and ulceration, hypermethylation of all four TRGs in SLN(+) paediatric patients with melanoma was equivalent to or less than in adults. With a median follow-up of 55 months, SLN(+) paediatric patients with melanoma with hypermethylation of > 1 TRG vs. ≤ 1 TRG had worse disease-free (P = 0·02) and overall survival (P = 0·02). CONCLUSIONS Differences in the methylation status of these TRGs in SLN(+) paediatric and adult patients with melanoma may account for why SLN(+) paediatric patients have different clinical outcomes. SLN biopsy should continue to be performed; within SLN(+) paediatric patients with melanoma, hypermethylation of TRGs can be used to identify a subpopulation at highest risk for poor outcomes who warrant vigilant clinical follow-up.
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Affiliation(s)
- K T Huynh
- Department of Molecular Oncology, John Wayne Cancer Institute, Santa Monica, CA 90404, USA
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Navid F. Genetic alterations in childhood melanoma. Am Soc Clin Oncol Educ Book 2012:589-592. [PMID: 24451801 DOI: 10.14694/edbook_am.2012.32.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Melanoma is rare in children. However, the clinical features of the disease in this population have been well-documented through single-institution experiences and population-based analyses. Still, our understanding of the etiologic factors in children remains unclear and diagnosis of melanoma remains challenging in certain cases. This article reviews emerging evidence indicating that molecular characterization of these lesions in children may be of diagnostic and therapeutic value.
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Affiliation(s)
- Fariba Navid
- From the Division of Solid Malignancies, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
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40
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Sung JY, Ahn HK, Kwon JE, Jeong H, Baek CH, Son YI, Ahn YC, Park K, Ahn MJ, Ko YH. Reappraisal of KIT mutation in adenoid cystic carcinomas of the salivary gland. J Oral Pathol Med 2011; 41:415-23. [PMID: 22077630 DOI: 10.1111/j.1600-0714.2011.01105.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND While overexpression of KIT protein has been well documented in adenoid cystic carcinomas (ACCs), mutation of KIT gene has been a controversial issue. We wanted to evaluate clinical value of the KIT mutation and protein expression in ACC. METHODS We analyzed 33 cases of ACC. Gene mutations in KIT exons 9, 11, 13, and 17 were analyzed using paraffin-embedded tissue, and two different sets of primers with direct sequencing after polymerase chain reaction (PCR) for exon 9, 11, 13, and 17, and cloning of PCR products for exon 11. KIT protein expression was assessed by immunohistochemistry. The correlation between clinicopathological findings and these biomarkers was analyzed. RESULTS No KIT mutation was observed in all of the 33 cases. With one primer set, KIT mutation was found in nine of 33 cases (27.3%). However, these mutations were not reproducible in the experiment using another primer set. KIT protein overexpression was detected in 22 of 33 patients (66.7%). KIT protein expression was not statistically correlated with either clinicopathological factors or survival. Patients with metastasis showed a tendency of longer progression-free survival (P = 0.052) and overall survival (P = 0.080) when the tumor overexpressed KIT protein. CONCLUSION This study supports that mutational study using paraffin-embedded tissue should be interpreted with great caution. KIT gene mutation is very rare in ACC, and gene mutation is not the cause of protein overexpression. KIT protein expression may have a potential value for better prognostic factor in patients with metastasis.
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Affiliation(s)
- Ji-Youn Sung
- Department of Pathology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
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Lee JH, Choi JW, Kim YS. Frequencies of BRAF and NRAS mutations are different in histological types and sites of origin of cutaneous melanoma: a meta-analysis. Br J Dermatol 2011; 164:776-84. [PMID: 21166657 DOI: 10.1111/j.1365-2133.2010.10185.x] [Citation(s) in RCA: 302] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND There have been conflicting data regarding the prevalence and clinicopathological characteristics of BRAF and NRAS mutations in primary cutaneous melanoma. OBJECTIVES To solve this controversy, this study used a meta-analysis to evaluate the frequencies of BRAF and NRAS mutations, and the relationship between these mutations and clinicopathological parameters of cutaneous melanoma. METHODS Data from studies published between 1989 and 2010 were combined. The BRAF and NRAS mutations were reported in 36 and 31 studies involving 2521 and 1972 patients, respectively. The effect sizes of outcome parameters were calculated by odds ratios (OR). RESULTS BRAF and NRAS mutations were reported in 41% and 18% of cutaneous melanomas, respectively. The mutations were associated with histological subtype and tumour site, but not with age and sex. The BRAF mutation was frequently detected in patients with superficial spreading melanoma (OR=2·021; P<0·001) and in melanomas arising in nonchronic sun-damaged skin (OR=2·043; P=0·001). In contrast, the NRAS mutation was frequently evident in patients with nodular melanoma (OR=1·894; P<0·001) and in melanomas arising in chronic sun-damaged skin (OR=1·887; P=0·018). CONCLUSIONS This pooled analysis shows that the incidences of BRAF and NRAS mutations in cutaneous melanomas differ according to histological type and tumour location based on the degree of sun exposure.
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Affiliation(s)
- J-H Lee
- Department of Pathology, Korea University Ansan Hospital, 516, Gojan-1 Dong, Danwon-Gu, Ansan-Si, Gyeonggi-Do 425-707, Korea
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Romagosa C, Simonetti S, López-Vicente L, Mazo A, Lleonart ME, Castellvi J, Ramon y Cajal S. p16(Ink4a) overexpression in cancer: a tumor suppressor gene associated with senescence and high-grade tumors. Oncogene 2011; 30:2087-97. [PMID: 21297668 DOI: 10.1038/onc.2010.614] [Citation(s) in RCA: 319] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
p16(Ink4a) is a protein involved in regulation of the cell cycle. Currently, p16(Ink4a) is considered a tumor suppressor protein because of its physiological role and downregulated expression in a large number of tumors. Intriguingly, overexpression of p16(Ink4a) has also been described in several tumors. This review attempts to elucidate when and why p16(Ink4a) overexpression occurs, and to suggest possible implications of p16(Ink4a) in the diagnosis, prognosis and treatment of cancer.
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Affiliation(s)
- C Romagosa
- Pathology Department, Fundació Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Response to Griewank and Bastian. J Invest Dermatol 2010. [DOI: 10.1038/jid.2010.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Comment on “Cutaneous Melanoma in Childhood and Adolescence Shows Frequent Loss of INK4A and Gain of KIT”. J Invest Dermatol 2010; 130:2330-1; author reply 2331-2. [DOI: 10.1038/jid.2010.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Berk DR, LaBuz E, Dadras SS, Johnson DL, Swetter SM. Melanoma and melanocytic tumors of uncertain malignant potential in children, adolescents and young adults--the Stanford experience 1995-2008. Pediatr Dermatol 2010; 27:244-54. [PMID: 20403119 DOI: 10.1111/j.1525-1470.2009.01078.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pediatric melanoma is difficult to study because of its rarity, possible biological differences in preadolescents compared with adolescents, and challenges of differentiating true melanoma from atypical spitzoid neoplasms. Indeterminant lesions are sometimes designated as melanocytic tumors of uncertain malignant potential (MelTUMPs). We performed a retrospective, single-institution review of melanomas, MelTUMPs and Spitz nevi with atypical features (SNAFs) in patients at 21 years of age and younger from 1995 to 2008. We identified 13 patients with melanoma, seven with MelTUMPs, and five with SNAFs. The median age for melanoma patients was 17 years, 10 for MelTUMPs, and six for SNAFs. Of the 13 melanoma patients, only four were younger than 15 years, while six were adolescents, and three were young adults. Nine melanoma patients (69%) were female. The most common histologic subtype was superficial spreading. The median depth for melanomas was 1.2 mm, and 3.4 mm for MelTUMPs. Microscopic regional nodal involvement detected on elective or sentinel lymph node (SLN) dissection was present in 2/10 (20%) of primary melanomas and 2/6 (33%) of Mel-TUMPs. Complete lymphadenectomy was performed on four melanoma patients, with three positive cases. Patient outcome through March 31, 2009 revealed no in-transit or visceral metastasis in patients with MelTUMPs or SNAFs. One SLN-positive patient (8%) with melanoma developed recurrent lymph node and liver metastasis and died 15 months after primary diagnosis. Our data highlight the rarity, female predominance, and significant rate of SLN positivity of pediatric melanoma. The high rate of MelTUMPs with regional nodal disease reinforces the need for close follow-up.
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Affiliation(s)
- David R Berk
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center, Stanford, California 94063, USA
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Fargnoli MC, Gandini S, Peris K, Maisonneuve P, Raimondi S. MC1R variants increase melanoma risk in families with CDKN2A mutations: A meta-analysis. Eur J Cancer 2010; 46:1413-20. [DOI: 10.1016/j.ejca.2010.01.027] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 01/18/2010] [Accepted: 01/20/2010] [Indexed: 01/27/2023]
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