Pediatric Melanoma: A 35-year Population-based Review

Abstract

Background: Melanoma is a rare neoplasm in the pediatric population. Recent publications suggest a possible increase in incidence over the past few decades. The purpose of this study was to analyze trends in pediatric patients diagnosed with malignant melanoma in British Columbia (BC) in the past 35 years.

Methods: A retrospective review was performed. All patients in BC diagnosed with melanoma before 18 years of age from 1979 to 2014 were included. Patient demographics, melanoma description, treatment details, and survival data were collected.

Results: Seventy-eight subjects were identified for the study. Patients were equally distributed by sex. Sixty-one (78%) of the subjects were diagnosed in the postpubertal age (≥12 years old). The most common sites of occurrence were the extremities (n = 33) and the trunk (n = 27), with the location on the trunk showing the highest mortality rate (22%). All patients were surgically treated and some had additional chemotherapy (12) and/or radiotherapy (12). Fatal outcome was recorded in 12 of the 78 subjects, 10 of whom had postpubertal diagnosis. The average time from date of diagnosis to date of death was 9.3 years.

Conclusions: The incidence of melanoma in the pediatric population remains exceedingly rare: less than 2.5 per million children younger than 18 years. The diagnosis is rarely made before puberty; the incidence is equal in males and females and has not changed over a 35-year time period in BC. Our study shows 85% survival with the majority of patients having had surgical excision only.

Fig. 1.

Pediatric patient status (alive or deceased) with reference to the year of diagnosis.

Fig. 2.

Current patient status (alive or deceased) with reference to their age at diagnosis with melanoma.

Fig. 3.

Sites of primary occurrence.

Fig. 4.

Patient status with reference to site of occurrence.

Fig. 5.

Classification of melanoma at diagnosis, according to International Classification of Diseases for Oncology, 3rd edition.

Fig. 6.

Treatment beyond excisional biopsy. CT, chemotherapy; RT, radiotherapy; SX, further surgery). *This patient was a 6-year-old child with neurocutaneous melanosis, which transformed into malignant melanoma of the CNS resulting in a fatal outcome 3 months after the diagnosis.

Fig. 7.

Distribution of pediatric melanoma in BC. Source: BC Stats. British Columbia School Districts, 2008. Reproduced and adapted with permission of the Province of British Columbia. Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.