The unique clinical characteristics of melanoma diagnosed in children

Abstract

Background: Studies have demonstrated a higher rate of nodal metastases in melanoma of childhood, but there is controversy about the overall prognosis relative to adults. We describe a large single-institution experience with pediatric melanoma and assess prognostic characteristics.

Methods: Retrospective review identified 126 patients diagnosed with melanoma at <21 years of age and referred for treatment from 1986 to 2011. Atypical lesions were excluded. Clinicopathologic characteristics were correlated with sentinel lymph node (SLN) status and outcomes.

Results: SLN biopsy was positive in 18 of 62 cases (29 %). Increasing Breslow thickness correlated with a positive SLN (p < 0.05). After a median follow-up of 5 years, there were 27 recurrences and 20 deaths. Positive SLN patients had significantly worse recurrence-free survival (RFS, p < 0.05) and significantly worse melanoma-specific survival (MSS, p = 0.05) compared with negative SLN patients. The 5-year RFS and MSS for positive SLN patients were 59.5 and 77.8 %, compared with 93.7 and 96.8 % for negative SLN patients. Recurrences and melanoma-related deaths were often seen beyond 5 years. No deaths have occurred in patients <12 years, but 9.1 % of patients 12-17 years and 17.2 % of patients 18-20 years died from melanoma (p = 0.291).

Conclusions: Children with melanoma have higher rates of SLN metastases (29 %) than adults with comparable melanomas. Despite the higher incidence of nodal metastases, survival is equal to or better than what is reported for adults. However, long-term follow-up is necessary in this population since recurrences and deaths are often seen beyond 5 years.

FIG. 1

Breakdown of pediatric melanoma patients. Sentinel lymph node (SLN) biopsy (SLNB) was performed in 62 cases with 18 cases (29 %) having a positive SLN. A SLNB was not performed in 64 cases and the reasons why not are listed

FIG. 2

Melanoma-specific survival in pediatric melanoma patients who presented with clinically localized disease as stratified by age groups

FIG. 3

Survival for pediatric melanoma patients as stratified by sentinel lymph node (SLN) status. a Recurrence-free survival was significantly worse for positive SLN patients compared with negative SLN patients (p < 0.05). b Melanoma-specific survival was significantly worse for positive SLN patients compared with negative SLN patients (p = 0.05)