Melanoma may behave differently in children than in adults

The clinical presentation of melanoma in children differs from that in adults, according to a report in the March issue of Pediatrics.

"Pediatricians must be aware that melanoma does occur in children, but the diagnosis is difficult and requires experience," Dr. Andrea Ferrari from Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy told Reuters Health.Dr. Ferrari and colleagues analyzed the clinical findings, treatment, and outcome of 33 cutaneous melanoma patients ranging in age from 3 to 14 years old to ascertain whether childhood melanoma differed clinically or prognostically from melanoma in adults.Half of the children had clinically amelanotic lesions, the authors report, and nearly three quarters of the lesions were raised. This is a higher frequency than seen in adults.Twenty-eight children underwent adequate excision of the primary lesion, the report indicates, but only five received adjuvant therapies.After a median follow-up of just over 10 years, 21 patients were alive in first complete remission, the researchers note, yielding overall survival and event-free survival rates at 10 years of 65.7% and 56.2%, respectively.Ten of the 13 patients who relapsed died of disease, two were alive in second complete remission, and one was in third complete remission, the results indicate.Children who were younger than 10 years had significantly better 5-year event-free survival even when their presenting clinical features seemed worse, the investigators report. There was only one recurrence among these 10 children."Considering our series as a whole," the authors conclude, "no major differences in outcome were found between childhood and adult melanoma.""It is important to recognize the possibility of this uncommon disease in children and to biopsy skin lesions that appear suspicious or about which the patient or parent has concern," write Dr. Julie R. Lange and Dr. Charles M. Balch from Johns Hopkins Medical Institutions, Baltimore, in a related commentary. "More study is needed of this special population, and we encourage more epidemiologic, biological, and clinical studies focusing on children and teenagers with melanoma.""The Italian cooperative group AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) recently founded a national study group on Pediatric Rare Tumors," Dr. Ferrari said. "Cutaneous melanoma is included in this group.""For childhood melanoma, we formulated therapeutic recommendations that remain the same as for adults," Dr. Ferrari concluded. "Since early diagnosis remains the most reliable way to cure patients with melanoma, we believe that pediatricians should refer the evaluation to expert physicians professionally dedicated to melanoma (to avoid delay in diagnosis but also overtreatment of benign lesions)."(Source: Pediatrics 2005;115:649-654,802-803: Reuters Health: Will Boggs, MD: March 2005.)