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Children with malignant melanoma: a single center experience from Turkey
Sema Büyükkapu Bay1, Ömer Görgün1,2, Rejin Kebudi1,2
1Department of Pediatric Hematology-Oncology, İstanbul University, Oncology Institute, İstanbul, Turkey.
Aim:
Malignant melanoma is the most frequent skin cancer in children and adolescents. It comprises 1-3% of all malignancies. In this study, we aimed to evaluate the clinical aspects, histopathologic features, and treatment outcomes of our patients with malignant melanoma.
Material And Methods:
Patients aged <15 years who were treated between 2003 and 2018 for malignant melanoma were retrospectively analyzed.
Results:
Seventeen patients (10 females, 7 males), with a median age of 7 years (range, 7 months-13 years) were evaluated. Five patients had congenital melanocytic nevi. All had cutaneous melanoma except one with mucosal (conjunctival) melanoma. The most frequent primary tumor site was the lower extremities (35%). Sentinel lymphoscintigraphy, sentinel node biopsy, and PET/CT were performed as the staging procedures at initial diagnosis. Localized disease was present in eight patients; nine had regional lymph node metastasis. The only treatment was surgery in localized disease; surgery and adjuvant interferon treatment was given in patients with regional lymph node metastasis. Three developed distant metastasis (bone, lung, brain) at a median of 9 months. A three-year-old patient received a BRAF inhibitor (vemurafenib), and a 13-year-old patient received a check point inhibitor (ipilimumab); both died of progressive disease. The median follow-up for all patients was 25 months. The 5-year overall survival was 76.6%.
Conclusion:
Although malignant melanoma is rare in children, prognosis is good if diagnosed early. Physicians should be aware of skin lesions and full-layer biopsy should be obtained in suspicious skin lesions. Patients with congenital melanocytic nevi should also be followed up cautiously.
Insights
Pediatric malignant melanoma, though rare, has a good prognosis with early diagnosis. Careful monitoring of suspicious skin lesions and congenital melanocytic nevi is crucial for better outcomes in children.
Area of Science:
- Pediatric Oncology
- Dermatology
- Cancer Research
Background:
- Malignant melanoma is the most common skin cancer in pediatric and adolescent populations, accounting for 1-3% of all childhood malignancies.
- Early detection and understanding of clinical and histopathologic features are vital for improving patient outcomes.
Purpose of the Study:
- To evaluate the clinical characteristics, histopathologic findings, and treatment outcomes of malignant melanoma in patients under 15 years old.
- To identify key factors influencing prognosis and inform clinical management strategies.
Main Methods:
- Retrospective analysis of pediatric patients (<15 years) diagnosed and treated for malignant melanoma between 2003 and 2018.
- Inclusion of clinical data, histopathology, staging procedures (sentinel lymphoscintigraphy, sentinel node biopsy, PET/CT), and treatment modalities.
Main Results:
- Seventeen patients (median age 7 years) were analyzed; 5 had congenital melanocytic nevi. Most cases were cutaneous melanoma, with lower extremities being the most frequent primary site (35%).
- Eight patients had localized disease, while nine presented with regional lymph node metastasis. Three patients developed distant metastasis. Targeted therapies (BRAF and checkpoint inhibitors) were administered to two patients, both with fatal progressive disease.
- The 5-year overall survival rate was 76.6%, with a median follow-up of 25 months.
Conclusions:
- Malignant melanoma in children, while uncommon, demonstrates a favorable prognosis when detected early.
- Physicians must maintain high awareness of suspicious skin lesions, advocating for full-layer biopsies. Vigilant follow-up of patients with congenital melanocytic nevi is also recommended.