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Abstract
Age plays a dynamic role in incidence, presentation, and extent of disease for cutaneous melanoma. Even within the spectrum of juvenile melanoma, there exists a range of spitzoid and nonspitzoid melanocytic and melanoma lesions. Spitzoid melanomas, a more favorable disease in juvenile patients, are malignant lesions and require treatment as such. Lymph node metastases in melanoma occur at lower rates in older patients compared with younger counterparts, yet the rate of metastases is still high. Age appears to play an important role in the development and progression of melanoma, and understanding the differences across age populations is important when counseling patients.
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Affiliation(s)
- Adrienne B Shannon
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Maloney, Philadelphia, PA 19104, USA.
| | - Yun Song
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Maloney, Philadelphia, PA 19104, USA
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 Founders, Philadelphia, PA 19104, USA
| | - Giorgos C Karakousis
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Silverstein, Philadelphia, PA 19104, USA
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Ryan AL, Burns C, Gupta AK, Samarasekera R, Ziegler DS, Kirby ML, Alvaro F, Downie P, Laughton SJ, Cross S, Hassall T, McCowage GB, Hansford JR, Kotecha RS, Gottardo NG. Malignant Melanoma in Children and Adolescents Treated in Pediatric Oncology Centers: An Australian and New Zealand Children's Oncology Group (ANZCHOG) Study. Front Oncol 2021; 11:660172. [PMID: 33996584 PMCID: PMC8117414 DOI: 10.3389/fonc.2021.660172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Unlike adults, malignant melanoma in children and adolescents is rare. In adult melanoma, significant progress in understanding tumor biology and new treatments, including targeted therapies and immunotherapy have markedly improved overall survival. In sharp contrast, there is a paucity of data on the biology and clinical behavior of pediatric melanoma. We report a national case series of all pediatric and adolescent malignant melanoma presenting to ANZCHOG Childhood Cancer Centers in Australia and New Zealand. METHODS A retrospective, descriptive, multi-center study was undertaken to identify patients less than 18 years of age treated for cutaneous malignant melanoma over a twenty-year period (1994 to 2014). Data on clinical characteristics, histopathology, and extent of disease, treatment and follow-up are described. RESULTS A total of 37 cases of malignant melanoma were identified from all of the Australasian tertiary Childhood Cancer Centers. The median age was 10 years (range 1 month - 17 years). Clinically, the most common type of lesion was pigmented, occurring in sixteen (57%) patients, whilst amelanotic was seen in 7 patients (25%). In 11 (27.9%) the Breslow thickness was greater than 4mm. A total of 11 (29.7%) patients relapsed and 90% of these died of disease. Five-year event free survival (EFS) and overall survival were 63.2 (95% CI: 40.6 - 79.1) and 67.7% (95% CI: 45.1 - 82.6) respectively. CONCLUSION Our data confirms that melanoma is a rare presentation of cancer to tertiary Australasian Childhood Cancer Centers with only 37 cases identified over two decades. Notably, melanoma managed in Childhood Cancer Centers is frequently at an advanced stage, with a high percentage of patients relapsing and the majority of these patients who relapsed died of disease. This study confirms previous clinical and prognostic information to support the early multidisciplinary management in Childhood Cancer Centers, in conjunction with expert adult melanoma centers, of this rare and challenging patient group.
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Affiliation(s)
- Anne L. Ryan
- Department of Haematology, Oncology and Bone Marrow Transplant, Perth Children’s Hospital, Perth, WA, Australia
| | - Charlotte Burns
- Children’s Cancer Centre, The Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Aditya K. Gupta
- Cancer Centre for Children, The Children’s Hospital at Westmead, Westmead, NSW, Australia
| | | | - David S. Ziegler
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Maria L. Kirby
- Department of Haematology/Oncology, Women’s and Children’s Hospital, Adelaide, SA, Australia
| | - Frank Alvaro
- Department of Haematology/Oncology, John Hunter Children’s Hospital, Newcastle, NSW, Australia
| | - Peter Downie
- Children’s Cancer Centre, The Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Haematology/Oncology, Monash Children’s Hospital, Melbourne, VIC, Australia
| | - Stephen J. Laughton
- Starship Blood and Cancer Centre, Starship Children’s Hospital, Auckland, New Zealand
| | - Siobhan Cross
- Children’s Haematology/Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Timothy Hassall
- Department of Haematology/Oncology, Queensland Children’s Hospital, Brisbane, QLD, Australia
| | - Geoff B. McCowage
- Cancer Centre for Children, The Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Jordan R. Hansford
- Children’s Cancer Centre, The Royal Children’s Hospital, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute; Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Rishi S. Kotecha
- Department of Haematology, Oncology and Bone Marrow Transplant, Perth Children’s Hospital, Perth, WA, Australia
- Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA, Australia
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Nicholas G. Gottardo
- Department of Haematology, Oncology and Bone Marrow Transplant, Perth Children’s Hospital, Perth, WA, Australia
- Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA, Australia
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Purim KÁSM, DE-PrÁ MV, Bahr DC, Hayakawa GS, Rossi GH, Soares LDEP. Survival analysis of children and adolescents with melanoma. ACTA ACUST UNITED AC 2020; 47:e20202460. [PMID: 33263650 DOI: 10.1590/0100-6991e-20202460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/01/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES to analyze the survival in juvenile melanoma. METHODS retrospective study conducted by hospital record review and cancer records of patients aged 0 to 19 years, with histologically proven melanoma and treated between 1997 and 2017 at the Erasto Gaertner Hospital in Curitiba-PR. RESULTS the sample comprised 24 patients, female (62.5%), mean 14.14 ± 4.72 years old, with head and neck melanoma (37.5%), chest (25%) and extremities. (20.8%). Signs and symptoms at diagnosis were increased lesion size (25%), bleeding (20.8%) and pruritus (16.6%). There was a Breslow II and IV index and Clark IV level, with a statistical tendency between Breslow IV and death (p = 0.127), and significance between Clark V and death (p = 0.067). Nine (37.5%) patients had metastases, six (25%) with distant metastases died (p = 0.001), five were girls (20.8%). Surgery was the standard treatment and chemotherapy the most used adjuvant (37.5%). The average time between diagnosis and death was 1.3 ± 1.2 years and survival were 3.7 ± 3.2 years. CONCLUSION there was a delay in diagnosis, high morbidity and mortality and average survival less than five years.
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