Melanomas in children and adolescents: Clinicopathologic features and survival outcomes

Mary-Ann El Sharouni; Robert V Rawson; Alison J Potter; Elizabeth C Paver; James S Wilmott; Arjen J Witkamp; Vigfús Sigurdsson; Paul J van Diest; Richard A Scolyer; John F Thompson; Serigne N Lo; Carla H van Gils

doi:10.1016/j.jaad.2022.08.067

Melanomas in children and adolescents: Clinicopathologic features and survival outcomes

J Am Acad Dermatol. 2023 Mar;88(3):609-616. doi: 10.1016/j.jaad.2022.08.067. Epub 2022 Dec 9.

Authors

Affiliations

¹ Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
² Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia.
³ Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
⁴ Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁵ Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁶ Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁷ Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
⁸ Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. Electronic address: john.thompson@melanoma.org.au.
⁹ Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
¹⁰ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands.

PMID: 36509217
DOI: 10.1016/j.jaad.2022.08.067

Abstract

Background: Melanomas in the first 2 decades of life are uncommon and poorly understood.

Objective: To assess clinicopathologic features and survival of children (≤11 years) and adolescents (12-19 years) diagnosed with melanoma.

Methods: A pooled cohort of 514 patients was analyzed (397 Dutch, 117 Australian; 62 children, 452 adolescents). Pathology reports were reevaluated to determine melanoma subtypes. Multivariable Cox models were generated for recurrence-free survival (RFS) and overall survival (OS).

Results: Melanoma subtypes were conventional melanoma (superficial spreading, nodular, desmoplastic, and acral lentiginous), spitzoid melanoma, and melanoma associated with a congenital nevus in 428, 78, and 8 patients, respectively. Ten-year RFS was 91.5% (95% confidence interval [CI], 82.4%-100%) in children and 86.4% (95% CI, 82.7%-90.3%) in adolescents (P = .32). Ten-year OS was 100% in children and 92.7% (95% CI, 89.8%-95.8%) in adolescents (P = .09). On multivariable analysis possible only for the adolescent cohort due to the small number of children, ulceration status, and anatomic site were associated with RFS and OS, whereas age, sex, mitotic index, sentinel node status and melanoma subtype were not. Breslow thickness >4 mm was associated with worse RFS.

Limitations: Retrospective study.

Conclusions: Survival rates for children and adolescents with melanomas were high. Ulceration, head or neck location and Breslow thickness >4 mm predicted worse survival in adolescents.

Keywords: adolescence; age; children; melanoma; survival.

MeSH terms

Adolescent
Australia
Child
Humans
Melanoma* / pathology
Prognosis
Retrospective Studies
Sentinel Lymph Node Biopsy
Skin Neoplasms* / pathology
Survival Rate