Adjuvant and neoadjuvant chemotherapy with dacarbazine in high-risk childhood melanoma

Four of four children with clinical Stage II-IIIB childhood melanoma treated at The University of Texas System Cancer Center M.D. Anderson Hospital with surgical excision of gross disease and adjuvant or neoadjuvant chemotherapy with dimethyl triazeno-imidazole carboxamide (dacarbazine) were alive without evidence of disease at 2, 6, 9.5, and 10.5 years after treatment. In one of the four patients suspected pulmonary nodules developed shortly after the start of chemotherapy, but regressed completely with continued treatment. In another patient with a primary left wrist melanoma and palpable epitrochlear and axillary nodes, there was dramatic shrinkage of nodal disease during chemotherapy and subsequent biopsies were cytologically negative. The expected survival of children with this rare condition when diagnosed at a comparably advanced stage and treated primarily by surgery is 32% compared with the 100% survival in these four cases. Although dacarbazine has not been notably successful as adjuvant therapy in high-risk adult melanoma, data from this small series is suggestive of an adjuvant effect in high-risk childhood melanoma and merits further study although the rarity of this condition may make a controlled trial difficult.