Prognostic factors for melanoma in children and adolescents

Abstract

BACKGROUND: Cutaneous melanoma in childhood is rare; therefore, its prognostic factors and biologic behavior and the effectiveness of adjuvant diagnostic techniques in this group remain mostly unknown. METHODS: The authors conducted a retrospective, observational study on the prognostic significance of clinical and pathologic findings from 137 cutaneous and mucosal melanomas in patients aged <18 years that were reviewed by the pathology department of a large cancer center during the period from 1992 to 2006. RESULTS: Univariate analysis indicated that there was a significantly greater risk of metastases for patients who had previous nonmelanocytic malignancies, nodular histologic type, fusiform or spitzoid cytology, high Breslow thickness, vertical growth phase, high dermal mitotic activity, ulceration, and vascular invasion. Adjacent nevus and radial growth phase were associated with a better prognosis. Twelve patients (10.3%) died during follow-up. Decreased overall survival was related significantly to age >10 years, previous nonmelanocytic malignancy, high Breslow thickness, high Clark level, and the presence of metastases at diagnosis. All patients who died were aged !11 years, and 8 of those patients had metastases at diagnosis. In multivariate analysis, higher Breslow thickness predicted an increased risk of metastases, whereas age >10 years and the presence of metastases at diagnosis were associated with decreased survival. CONCLUSIONS: Similar to adults, the detection of metastases at diagnosis in children with melanoma was 1 of the main factors that influenced overall survival. Melanomas that were detected in children aged <11 years appeared to have a less aggressive behavior than those detected in adults. Cancer 2010;116:4334-44.

Pigment Cell Skin Neoplasms in Children and Adolescents: Searching Skin Melanoma Diagnostic Markers

“…Оказалось, что общая десятилетняя выживаемость этих больных статистически достоверно зависе-ла от их возраста: при среднем значении данно-го показателя 80,6% для всех пациентов в группе больных не старше 10 лет он составил 100%, в группе старше 10, но не более 15 лет -69,7%, а среди больных старше 15 и до 20 лет включитель-но -79,5%. Ранее аналогичную тенденцию выяви-ли S. Paradela и соавт., проведя ретроспективный анализ 137 случаев МК, а также меланомы слизи-стых оболочек у пациентов в возрасте до 18 лет [14]. Результаты исследования указывают на раз-личия в биологической структуре МК, возникаю-щей у молодых пациентов, относящихся к разным возрастным группам.…”

“…О сходстве сообщили Livestro и соавт., выявившие одинаковую выживаемость молодых и взрослых больных МК в случаях, если пациенты имели первичную опухоль равной толщины; те же авторы, однако, выявили достоверно более высо-кую частоту метастазирования МК у детей и под-ростков в лимфатические узлы по сравнению с таковой у взрослых больных [28]. Установлено, что общая десятилетняя выживаемость молодых боль-ных МК достоверно колеблется в зависимости от их возраста [12,14]. Неодинаковая метастатиче-ская активность МК у пациентов разных возраст-ных групп и разная выживаемость больных МК, являясь интегральными характеристиками опухоли, по-видимому, отражают различия в молекулярном фенотипе меланомы у данных категорий наблюда-емых.…”

The Unique Clinical Characteristics of Melanoma Diagnosed in Children

“…4,7,8,11–22 Despite the higher rate of nodal disease in pediatric patients, SEER-based and case-matched studies on pediatric melanoma have shown survival rates similar to those seen in adults with melanoma. 6,13 These observations suggest that the biology of melanoma in children may be different from melanoma in adults.…”

Health-Related Quality of Life in Children with Cancer

“…The use of biological response modifiers like Interferon-α in melanoma have been reported to affect adults with melanoma. 33 However, our small group of children with melanoma generally reported the highest HRQL outcomes across diagnostic groups at all time-points. These responses provide an insight into the general tolerance of melanoma treatment in adolescents with cancer (15 out of 23 participants in the melanoma group were adolescents).…”

“…Optimal treatment for melanoma is complete surgical removal and is dependent upon the size, site, level of invasion into the skin and stage of the tumor. 33 Prognosis for resected superficial melanomas is approximately 90%, with patients surviving 10 years from diagnosis. Survival is decreased if the melanoma has spread to distant organs.…”