Download - Catalyst - University of Washington

PEDIATRIC MELANOMA
Brinkley K. Sandvall, MD
Patient AW
•12 yo M
•No prior PMH / PSH
•Left supraclavicular skin lesion
•Darker, more raised x 3 months
•Shave bx  melanoma
•No palpable lymphadenopathy
Wide Local Excision
Tumor Thickness
In situ
<= 1.0 mm
1.01 - 2 mm
2.01 – 4 mm
>=4 mm
Recommended
Clinical Margin
0.5 cm
1 cm
1-2 cm
2 cm
2 cm
Patient AW
Patient AW
Questions
1. Do children with melanoma differ from
adults in presentation? In outcomes?
2. Do older children with melanoma
differ substantially from younger children?
Risk Factors
• Fair Skin, light colored hair / eyes
• Female
• Increasing age
• Presence of nevi
• Family history of melanoma
• Disorders of DNA repair
• Immunosuppression
• Previous history of malignancy
• Sunburns
• Exposure to UV radiation
Mode of Occurrence
• Transplacental melanoma
• Transformation from giant congenital
melanocytic nevus
• In association with congenital
predisposing condition such as
xeroderma pigmentosum or dysplastic
nevus syndrome
•Development from healthy skin
•Development from a preexisting nevus
Incidence / Trend
• Rare
• Increasing
• 1-4% of melanomas
• 1-3% of pediatric malignancies
15-19yo F
15-19yo M
10-14yo F
10-14yo M
0-9yo F
0-9yo M
Detection Criteria
•ABCDE
-
Asymmetry
Border irregularity
Color variegation
Diameter >6mm
Evolution
Does conventional ABCDE criteria adequately
detect pediatric melanoma patients?
•Group A: 19 patients, 0-10 yo
– 60%
•Group B: 51 patients, 11-19yo
– 40%
Detection Criteria
•ABCDE
-
Asymmetry
Border irregularity
Color variegation
Diameter >6mm
Evolution
•Modified ABCD
-
Amelanotic
Bleeding, Bump
Color uniformity
De novo, Any diameter
Prognostic Factors
Similar to adult melanoma:
• Tumor thickness
• Ulceration
• Lymph node status
• Stage
Pediatric vs Adult
Outcomes
• LN metastases more prevalent in young patients
- 44% of children had positive LN (11/25 pts)
- 24% of adults had positive LN (11/46 pts)
• 5 and 10 year survival rates were similar
Pediatric vs Adult
Outcomes
•10 year overall survival
- Stage 1 = 100%
- Stage 2 = 80%
- Stage 3 = 77%
•Adults, 10 year overall survival
- Stage 1 = 86-95%
- Stage 2 = 40-67%
- Stage 3 = 24-68%
Prepubertal vs Adolescent
Outcomes
•10 year overall survival , according to age group
- 0 - 10yo = 100%
- 11 – 15yo = 69.7%
- 16 – 20yo = 79.5%
• In < 10yo group
- More advanced disease at presentation
- Trend toward increased survival
Prepubertal vs Adolescent
Outcomes
•More common in older children (75% > 15yo)
•Demogaphics, site, and stage change with age
• In <10yo group
-
More male
More non-white
More head / neck
Higher stage at presentation
Poorer survival
Prepubertal vs Adolescent
Outcomes
•Odds of positive SLNB decreased by 13% each year
with increasing age
•In <10yo group
-
More non-white
More vascular invasion
Thicker tumors
More SLNB positive
Perhaps younger kids
have a disease that
differs biologically from
that of older children?
• Survival did not differ by age group
Treatment
•Surgery
- Wide local excision
- Sentinel lymph node biopsy
- Complete lymph node dissection
•Adjuvant therapy
- Systemic Therapy
- Radiation
Patient AW
•Pathology report
1. Sentinel lymph node negative.
2. Prior biopsy site negative for
residual melanoma.
Patient AW
•What we did
•Pathology result
•Next steps / Surveillance
Thank you.
References
1. Aldrink JH, Selim MA, Diesen DL, Johnson J, Pruitt SK, Tyler DS, et al. Pediatric melanoma: a single-institution experience of 150patients. Journal of Pediatric
Surgery. Elsevier Inc; 2009Aug.1;44(8):1514–21.
2. Averbook BJ, Lee SJ, Delman KA,Gow KW, Zager JS, Sondak VK, et al. Pediatric melanoma: Analysisof an international registry. Cancer.
2013Sep.10;119(22):4012–9.
3. Downard CD, Rapkin LB, Gow KW. Melanoma in children andadolescents. Surgical Oncology. 2007Nov.;16(3):215–20.
4. Ferrari A, Bisogno G, Cecchetto G, Santinami M, Maurichi A, Bono A, et al. Cutaneous melanoma in children and adolescents: the Italian rare tumors in
pediatric age project experience. J. Pediatr.
2014Feb.;164(2):376–82.e1–2.
5. Han D, Zager JS, Han G, MarzbanSS, Puleo CA, Sarnaik AA, et al. The unique clinical characteristics ofmelanoma diagnosed in children. Ann. Surg. Oncol.
2012Nov.;19(12):3888–95.
6. Hawryluk EB, Liang MG. PediatricMelanoma, Moles, and Sun Safety. Pediatr. Clin. North Am. 2014Apr.;61(2):279–91.
7. Lange JR, Palis BE, Chang DC, Soong SJ, Balch CM. Melanoma in children and teenagers: an analysis ofpatients from the National Cancer Data Base. J.
Clin. Oncol. 2007Apr.10;25(11):1363–8.
8. MD KMC, MD DG, MD IJF, MD TM, MD MK-S. Pediatric melanoma: Results of a large cohort study andproposal for modified ABCD detection criteria
for&nbsp;children. Journal of American Dermatology. Elsevier Inc; 2013Jun.1;68(6):913–25.
9. Moore-Olufemi S, Herzog C, Warneke C, Gershenwald JE, Mansfield P, Ross M, et al. Outcomes in pediatricmelanoma: comparing prepubertal to
adolescent pediatric patients. Ann. Surg. 2011Jun.;253(6):1211–5.
10. Paradela S, Fonseca E, Pita-Fernández S, Kantrow SM, Diwan AH, Herzog C, et al. Prognosticfactors for melanoma in children and adolescents. Plast.
Reconstr. Surg. 2010Aug.19;116(18):4334–44.
11. Roaten JB, Partrick DA, Bensard D, Pearlman N, Gonzalez R, Fitzpatrick J, et al. Survival insentinel lymph node–positive pediatric melanoma. Journal
ofPediatric Surgery. 2005Jun.;40(6):988–92.
12. Roaten JB, PartrickDA, Pearlman N, Gonzalez RJ, Gonzalez R, McCarter MD. Sentinellymph node biopsy for melanoma and other melanocytic tumors
inadolescents. Journal of Pediatric Surgery 2005Jan.;40(1):232–5.
13. Senerchia AA, Ribeiro KB, Rodriguez-Galindo C. Trends inincidence of primary cutaneous malignancies in children, adolescents, and young adults: a
population-based study. Pediatr Blood Cancer.
2014Feb.;61(2):211–6.
14. Strouse JJ, Fears TR, Tucker MA, Wayne AS. Pediatric Melanoma: resk factor and survival analysis of the surveillance, epidemiology, and end results
database. J Clin Oncology 2005.
Lymph Nodes