Melanoma in Childhood and Adolescence: Clinicopathologic Analysis of 64 Cases.
Thomas Brenn, Wayne Grayson, Snjezana Frkovic-Grazio, Martin C Mihm, Eduardo Calonje, Phillip H McKee. Western General Hospital and The University of Edinburgh, United Kingdom; National Health Laboratory Service and the University of Witwatersrand, Johannesburg, South Africa; Insitute of Oncology, Ljubljana, Slovenia; Massachausetts General Hospital and Harvard University, Boston; St John's Institute of Dermatology, London, United Kingdom; Dermatopathology, Sedona, AZ
Background: The diagnosis of melanoma in children and adolescents is a significant challenge for both clinicians and pathologists due to the rarity of the disease, the often non-specific clinical presentation as well as the unusual histological features.
Design: 64 melanomas presenting before the 18th birthday were retrieved from the authors' consultation files. Hematoxylin and eosin-stained tissue sections as well as clinical and follow-up data were evaluated.
Results: Median age at presentation was 12 years (range: 2 months to 17 years) and there was a slight male predilection. No clinical pigment was evident in 11 tumors. The extremities were the most frequently affected site followed by the head and neck and trunk. 13 melanomas arose within a congenital nevus and 1 patient had a history of xeroderma pigmentosum. Histologically, median tumor thickness was 2.8 mm and the majority of tumors invaded at least into anatomic level IV (84%). The most frequent histological subtypes were Spitzoid (21) and nodular melanoma (21) followed by superficial spreading (12), nevoid (4), pigment synthesizing (3) and desmoplastic, neurotropic and acral lentiginous melanoma (1 each). Follow-up (median, 24 months) was available for 46 patients. Eighteen patients (39%) developed metastasis and 6 patients (13%) died from metastatic disease. Superficial spreading and nevoid subtypes occurred almost exclusively in adolescence (median: 16 years), only rarely affected the head and neck area and were associated with thinner tumor thickness (median: 1.0 and 1.1 mm). Nodular, Spitzoid and pigment synthesizing melanomas showed a wide age range (median: 11, 10 and 9 years) and anatomical distribution with deep tumor thickness (median: 4.0, 3.7 and 3.4 mm). Death from disease was observed only in patients with nodular melanoma.
Conclusions: This study further delineates the clinical and histological spectrum as well as clinical outcome of melanomas arising before the 18th birthday.
Monday, February 28, 2011 2:30 PM
Platform Session: Section F, Monday Afternoon