Malignant mela-noma is a rare neoplasm in the pediatric population, but its incidence has risen in recent years.
Methods
The literature was reviewed to define the current clinical and pathologic features of pediatric melanoma, highlighting the similarities and differences between adult and pediatric melanoma.
Results
Distinctive features of this disease, including frequency and type of genetic abnormalities, predisposing conditions, clinical presentation, stage at diagnosis, prognostic features, and frequency of sentinel lymph node positivity are emphasized. Treatment strategies, extrapolated from adult mela-noma trials, are also discussed.
Conclusions
Despite the differences between pediatric and adult melanoma, survival rates are similar and are improving in both populations. Further studies will help delineate the pathogenesis of both adult and pediatric melanoma, with the goal of contributing to early detection and improved survival.
References
1.
StrouseJ.J., FearsT.R., TuckerM.A.. Pediatric melanoma: risk factor and survival analysis of the surveillance, epidemiology and end results database.J Clin Oncol.2005; 23(21): 4735–4741.
2.
DownardC.D., RapkinL.B., GowK.W.. mela-noma in children and adolescents.Surg Oncol.2007; 16(3): 215–220. Epub 2007 Oct 31.
3.
LinaberyA.M., RossJ.A.. Trends in childhood cancer incidence in the U.S. (1992-2004).Cancer.2008; 112(2): 416–432.
4.
FisherD.E., MedranoE.E., McMahonM.. Meeting report: fourth international congress of the Society for mela-noma Research.Pigment Cell mela-noma Res.2008; 21(1): 15–26.
5.
PappoA.S.. mela-noma in children and adolescents.Eur J Cancer.2003; 39(18): 2651–2661.
6.
PappoA., RiesL., HerzogC.. Malignant mela-noma in the first three decades of life: a report from the U.S. Surveillance, Epidemiology and End Results (SEER) Program.J Clin Oncol, 2004 ASCO Annual Meeting Proceedings (Post-Meeting Edition).2004; 22 (14S July 15 suppl): 7557. Abstract.
7.
LewisK.G.. Trends in pediatric mela-noma mortality in the United States, 1968 through 2004.Dermatol Surg.2008; 34(2): 152–159. Epub 2007 Dec 17.
8.
LangeJ.R., PalisB.E., ChangD.C.. mela-noma in children and teenagers: an analysis of patients from the National Cancer Data Base.J Clin Oncol.2007; 25(11): 1363–1368.
9.
UribeP., WistubaI.I., SolarA.. Comparative analysis of loss of heterozygosity and microsatellite instability in adult and pediatric melanoma.Am J Dermatopathol.2005; 27(4): 279–285.
10.
ClarkW.H.Jr, ReimerR.R., GreeneM.. Origin of familial malignant melanomas from heritable melanocytic lesions. ‘The B-K mole syndrome’.Arch Dermatol.1978; 114(5): 732–738.
LinJ., HockerT.L., SinghM., TsaoH.. Genetics of mela-noma predisposition.Br J Dermatol.2008; 159(2): 286–291. Epub 2008 Jun 28.
13.
RouzaudF., KadekaroA.L., Abdel-MalekZ.A.. MC1R and the response of melanocytes to ultraviolet radiation.Mutat Res.2005; 571 (1-2): 133–152. Epub 2005 Jan 26.
14.
BoxN.F., DuffyD.L., ChenW.. MC1R genotype modifies risk of mela-noma in families segregating CDKN2A mutations.Am J Hum Genet.2001; 69(4): 765–773. Epub 2001 Aug 8.
15.
LandiM.T., BauerJ., PfeifferR.M.. MC1R germline variants confer risk for BRAF-mutant melanoma.Science.2006; 313(5786): 521–522. Epub 2006 Jun 29.
MarkovicS.N., EricksonL.A., RaoR.D.. Malignant mela-noma in the 21st century, part 1: epidemiology, risk factors, screening, prevention, and diagnosis.Mayo Clin Proc.2007; 82(3): 364–380.
18.
LivestroD.P., KaineE.M., MichaelsonJ.S.. mela-noma in the young: differences and similarities with adult melanoma. A case-matched controlled analysis.Cancer.2007; 110(3): 614–624.
19.
KraemerK.H., LeeM.M., AndrewsA.D.. The role of sunlight and DNA repair in mela-noma and nonmelanoma skin cancer: the xeroderma pigmentosum paradigm.Arch Dermatol.1994; 130(8): 1018–1021.
20.
TuckerM.A., GoldsteinA.M.. mela-noma etiology: where are we?Oncogene.2003; 22(20): 3042–3052.
21.
WhitemanD.C., ValeryP., McWhirterW.. Risk factors for childhood mela-noma in Queensland, Australia.Int J Cancer.1997; 70(1): 26–31.
GreeneM.H., GoldinL.R., ClarkW.H.Jr,. Familial cutaneous malignant melanoma: autosomal dominant trait possibly linked to the Rh locus.Proc Natl Acad Sci U S A.1983; 80(19): 6071–6075.
29.
TuckerM.A., HalpernA., HollyE.A.. Clinically recognized dysplastic nevi: a central risk factor for cutaneous melanoma.JAMA.1997; 277(18): 1439–1444.
30.
GoldsteinA.M., FraserM.C., ClarkW.H.Jr,. Age at diagnosis and transmission of invasive mela-noma in 23 families with cutaneous malignant melanoma/dysplastic nevi.J Natl Cancer Inst.1994; 86(18): 1385–1390.
31.
BauerJ., GarbeC.. Acquired melanocytic nevi as risk factor for mela-noma development: a comprehensive review of epidemiological data.Pigment Cell Res.2003; 16(3): 297–306.
32.
GarbeC., BüttnerP., WeissJ.. Risk factors for developing cutaneous mela-noma and criteria for identifying persons at risk: multicenter case-control study of the Central Malignant mela-noma Registry of the German Dermatological Society.J Invest Dermatol.1994; 102(5): 695–699.
33.
MilneE., SimpsonJ.A., EnglishD.R.. Appearance of melanocytic nevi on the backs of young Australian children: a 7-year longitudinal study.Melanoma Res.2008; 18(1): 22–28.
34.
JafarianF., PowellJ., KoktaV.. Malignant mela-noma in childhood and adolescence: report of 13 cases.J Am Acad Dermatol.2005; 53(5): 816–822. Epub 2005 Sep 29.
BoddieA.W.Jr, SmithJ.L.Jr, McBrideC.M.. Malignant mela-noma in children and young adults: effect of diagnostic criteria on staging and end results.South Med J.1978; 71(9): 1074–1078.
37.
FerrariA., BonoA., BaldiM.. Does mela-noma behave differently in younger children than in adults? A retrospective study of 33 cases of childhood mela-noma from a single institution.Pediatrics.2005; 115(3): 649–654.
38.
BonoA., FerrariA.. Early diagnosis remains the most reliable way to cure children with melanoma.Pediatr Blood Cancer.2005; 45(3): 355; author reply 356.
39.
RichardsonS.K., TannousZ.S., MihmM.C.Jr. Congenital and infantile melanoma: review of the literature and report of an uncommon variant, pigment-synthesizing melanoma.J Am Acad Dermatol.2002; 47(1): 77–90.
40.
AlexanderA., SamlowskiW.E., GrossmanD.. Metastatic mela-noma in pregnancy: risk of transplacental metastases in the infant.J Clin Oncol.2003; 21(11): 2179–2186.
SpitzS.. Melanomas of childhood. 1948.CA Cancer J Clin.1991; 41(1): 40–51.
43.
CelebiJ.T., MessinaJ.L.. Challenging melanocytic neoplasms: spitzoid mela-noma vs spitz nevus. In: AgarwalaS.S., SondakV.K., eds. Melanoma: Translational Research and Emerging Therapies.New York, NY: Informa Healthcare USA, Inc;2008.
44.
BarnhillR.L.. The Spitzoid lesion: rethinking Spitz tumors, atypical variants, ‘Spitzoid melanoma’ and risk assessment.Mod Pathol.2006; 19(Suppl 2): S21–33.
45.
CerroniL., BorroniR.G., MassoneC.. “Ancient” blue nevi (cellular blue nevi with degenerative stromal changes).Am J Dermatopathol.2008; 30(1): 1–5.
46.
BarnhillR.L., ArgenyiZ., BerwickM.. Atypical cellular blue nevi (cellular blue nevi with atypical features): lack of consensus for diagnosis and distinction from cellular blue nevi and malignant mela-noma (“malignant blue nevus”).Am J Surg Pathol.2008; 32(1): 36–44.
47.
MurphyM.J., JenM., ChangM.W.. Molecular diagnosis of a benign proliferative nodule developing in a congenital melanocytic nevus in a 3-month-old infant.J Am Acad Dermatol.2008; 59(3): 518–523. Epub 2008 Jul 21.
48.
LeechS.N., BellH., LeonardN.. Neonatal giant congenital nevi with proliferative nodules: a clinicopathologic study and literature review of neonatal melanoma.Arch Dermatol.2004; 140(1): 83–88.
BütterA., HuiT., ChapdelaineJ.Melanoma in children and the use of sentinel lymph node biopsy.J Pediatr Surg.2005; 40(5): 797–800.
51.
ShahN.C., GerstleJ.T., StuartM.. Use of sentinel lymph node biopsy and high-dose interferon in pediatric patients with high-risk melanoma: the Hospital for Sick Children experience.J Pediatr Hematol Oncol.2006; 28(8): 496–500.
52.
PacellaS.J., LoweL., BradfordC.. The utility of sentinel lymph node biopsy in head and neck mela-noma in the pediatric population.Plast Reconstr Surg.2003; 112(5): 1257–1265.
53.
RoatenJ.B., PartrickD.A., PearlmanN.. Sentinel lymph node biopsy for mela-noma and other melanocytic tumors in adolescents.J Pedi-atr Surg.2005; 40(1): 232–235.
54.
ToroJ., RanieriJ.M., HavlikR.J.. Sentinel lymph node biopsy in children and adolescents with malignant melanoma.J Pediatr Surg.2003; 38(7): 1063–1065.
55.
SondakV.K., TaylorJ.M., SabelM.S.. Mitotic rate and younger age are predictors of sentinel lymph node positivity: lessons learned from the generation of a probabilistic model.Ann Surg Oncol.2004; 11(3): 247–258.
56.
DurraniA.J., MoirG.C., Diaz-CanoS.J.. Malignant mela-noma in an 8-year-old Caribbean girl: diagnostic criteria and utility of sentinel lymph node biopsy.Br J Dermatol.2003; 148(3): 569–572.
57.
GamblinT.C., EdingtonH., KirkwoodJ.M.. Sentinel lymph node biopsy for atypical melanocytic lesions with spitzoid features.Ann Surg Oncol.2006; 13(12): 1664–1670.
58.
GurbuzY., ApaydinR., Muezzino luB.. A current dilemma in histopathology: atypical spitz tumor or Spitzoid melanoma?Pediatr Der-matol.2002; 19(2): 99–102.
59.
LohmannC.M., CoitD.G., BradyM.S.. Sentinel lymph node biopsy in patients with diagnostically controversial spitzoid melanocytic tumors.Am J Surg Pathol.2002; 26(1): 47–55.
60.
SuL.D., FullenD.R., SondakV.K.. Sentinel lymph node biopsy for patients with problematic spitzoid melanocytic lesions: a report on 18 patients.Cancer.2003; 97(2): 499–507.
61.
UrsoC., GelliR., BorgognoniL.. Positive sentinel node biopsy in a 30-month-old boy with atypical Spitz tumour (Spitzoid melanoma).Histopathology.2006; 48(7): 884–886.
62.
KirkwoodJ.M., StrawdermanM.H., ErnstoffM.S.. Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684.J Clin Oncol.1996; 14(1): 7–17.
63.
KirkwoodJ.M., IbrahimJ.G., SosmanJ.A.. High-dose interferon alfa-2b significantly prolongs relapse-free and overall survival compared with the GM2-KLH/QS-21 vaccine in patients with resected stage IIB-III melanoma: results of intergroup trial E1694/S9512/C509801.J Clin Oncol.2001; 19(9): 2370–2380.
64.
KirkwoodJ.M., ManolaJ., IbrahimJ.. A pooled analysis of eastern cooperative oncology group and intergroup trials of adjuvant high-dose interferon for melanoma.Clin Cancer Res.2004; 10(5): 1670–1677.
65.
NavidF., FurmanW.L., FlemingM.. The feasibility of adjuvant interferon alpha-2b in children with high-risk melanoma.Cancer.2005; 103(4): 780–787.
BalchC.M., SoongS.J., GershenwaldJ.E.. Prognostic factors analysis of 17,600 mela-noma patients: validation of the American Joint Committee on Cancer mela-noma staging system.J Clin Oncol.2001; 19(16): 3622–3634.
