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Malignant melanoma in children: its management and prognosis
B N Rao1, F A Hayes, C B Pratt
1Department of Surgery, St Jude Children's Research Hospital, Memphis, TN 38101.
Insights
Pediatric malignant melanoma is rare but requires careful staging. Deeper melanomas (Clark level IV/V) with localized disease can still progress, while thinner melanomas (<1.5 mm) show favorable outcomes.
Area of Science:
- Pediatric Oncology
- Dermatology
- Cancer Research
Background:
- Malignant melanoma is an uncommon pediatric malignancy, accounting for 1-3% of childhood cancers.
- This study reviews 33 cases of pediatric malignant melanoma treated between 1967 and 1988.
Purpose of the Study:
- To analyze the incidence, initial staging, prognosis, and survival of pediatric malignant melanoma.
- To compare the utility of Clark's level and Breslow's thickness in evaluating pediatric melanoma.
- To identify prognostic indicators for malignant melanoma in children.
Main Methods:
- Retrospective review of 33 pediatric malignant melanoma cases.
- Classification of disease stage at presentation (localized, regional node involvement, disseminated).
- Evaluation of primary tumor characteristics using Clark's level and Breslow's thickness.
Main Results:
- Most common sites were extremities (13) and trunk (9).
- Clark's level IV/V melanomas, even at stage I, showed a tendency for disease progression.
- Thinner melanomas (Breslow's depth <1.5 mm) in 5 patients were all stage I and showed no progression.
Conclusions:
- Clark's level and Breslow's thickness are important prognostic indicators in pediatric malignant melanoma.
- Early-stage, thinner melanomas (<1.5 mm) have a favorable prognosis.
- Deeper melanomas require close monitoring due to potential for progression even at early stages.
Abstract:
Malignant melanoma is rare in children, representing 1% to 3% of all pediatric malignancies. Thirty-three children with malignant melanoma were treated at St Jude Children's Research Hospital from 1967 to 1988. Their ages ranged from 1 day to 20 years (median, 12 years); 23 were boys and 10 were girls; and 5 of the 33 (15%) were black. Four of the 33 children had been treated for a previous malignancy. In 3, melanoma arose within a bathing trunk nevus. The extremity was the most common site (13), followed by the trunk (9), head and neck (7), and perineum (1). In 3 patients the primary site could not be determined. Upon initial presentation to St Jude Hospital, 17 patients had localized disease (stage I), 10 had regional node involvement (stage II), and the remaining 6 patients had disseminated disease (stage III). Using both Clark's level and Breslow's thickness as indicators, the incidence, initial stage, prognosis, and survival were compared. By Clark's level, 7 patients, (6 of whom were stage I) were level II or III, and 22 patients were level IV or V. Though 16 of 22 level IV and V patients were initially stage I, 10 patients eventually developed progressive disease. Similar observations were noted when using Breslow's thickness to evaluate the primary. In 5 of 27 evaluable patients, Breslow's depth of invasion was less than 1.5 mm. All 5 of these patients were diagnosed with stage I disease and have not shown progressive disease.