Melanoma in adolescents and young adults: special considerations

Melanoma in adolescents and young adults (AYAs, 15-39 years) occupies a unique position between pediatric and adult disease. Although uncommon, it represents a meaningful proportion of malignancies in this age group. Its distinct epidemiology, histopathological subtypes, and clinical features necessitate age-specific approaches. This review synthesizes current evidence to clarify the unique characteristics of AYA melanoma and to inform future research and clinical practice.

Emerging data reveal notable age- and sex-specific differences in anatomical distribution, stage at presentation, and molecular alterations. AYAs more often present with superficial spreading and Spitzoid melanomas, frequently driven by BRAF, NRAS, or kinase fusions. Genetic susceptibility often interacts with ultraviolet exposure and tanning behaviors. Management generally follows adult protocols, including conservative surgery, sentinel lymph node biopsy, and systemic immunotherapy or targeted therapies for advanced disease. Overall survival is favorable compared with older adults, though male patients consistently have worse outcomes. Survivors face an increased risk of second primary melanomas, highlighting the need for long-term surveillance. Psychosocial and reproductive health issues are increasingly recognized as essential components of care.

AYA melanoma requires tailored, multidisciplinary strategies that integrate prevention, molecular profiling, long-term follow-up, and dedicated research frameworks to optimize clinical outcomes.