Yves Réguerre1, Marie Vittaz2, Daniel Orbach3, Caroline Robert4, Christine Bodemer5, Christina Mateus4, Dominique Plantaz6, Emmanuel Plouvier7, Patrick Lutz8, Josue Rakotonjanahary9, Sylvie Fraitag10, Ludovic Martin11. 1. Oncology and Hematology Unit, CHU de Saint Denis de La Réunion, Saint Denis, France. French Pediatric Rare Tumor Group (groupe Fracture). yves.reguerre@chu-reunion.fr. 2. Pediatric Departement, CH Le Mans, Le Mans, France. 3. Department of Pediatrics, Adolescent, Young Adult Oncology, Institut Curie, Paris, France. French Pediatric Rare Tumor group (groupe Fracture). 4. Dermatology Department, Gustave Roussy Cancer Campus, Villejuif, France. 5. Dermatology Department, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 6. Oncology and Hematology Unit, Grenoble University Hospital, Grenoble, France. 7. Oncology and Hematology Unit, Besançon University Hospital, Besançon, France. 8. Oncology and Hematology Unit, Strasbourg University Hospital, Strasbourg, France. 9. Oncology and Hematology Unit, Angers University Hospital, Angers, France. 10. Pathology Department, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 11. Dermatology Department, Angers University Hospital, Angers, France.
Abstract
OBJECTIVES: Recent progress in the understanding of tumor biology and new targeted therapies has led to improved survival in adults with malignant melanoma (MM). MM is rare in children, especially before puberty. We report here our experience with pediatric patients with MM, describe the clinical presentation, treatment and evolution, and compare prepubescent and postpubescent disease. METHODS: A retrospective, descriptive, national multicenter study was undertaken of 52 cases of MM in children and adolescents. Demographic, histopathology, treatment evolution data, and survival distributions are described. RESULTS: Median age was 15 years (5-18). The tumors were often amelanotic (45%) and raised (83%), and Breslow thickness was greater than 4 mm in 35% of cases. Histological examination showed superficial spreading (n = 16) or spitzoid (n = 16) or nodular (n = 9) pattern. Twelve children (23%) were less than 10 years of age. The spitzoid histotype was more frequent in prepubescent children (seven of 12). Seventeen patients relapsed, of whom four had skin lesions initially diagnosed as benign. Ten patients died after relapse. Five-year event-free survival and overall survival were 62.7% (95% confidence interval [CI]: 45.3-76) and 75.5% (95% CI: 56.8-87.1), respectively. CONCLUSIONS: MM appears to be different in prepubescent children, of whom most had a spitzoid histotype. Diagnosis can be difficult, leading to delay in treatment. New biological tools to identify targets for treatment in MM and to differentiate spitzoid melanomas from Spitz nevi now exist. As effective targeted therapies are now available, we recommend requesting biological examination of all melanocyte-derived skin lesions in children that could be malignant.
OBJECTIVES: Recent progress in the understanding of tumor biology and new targeted therapies has led to improved survival in adults with malignant melanoma (MM). MM is rare in children, especially before puberty. We report here our experience with pediatric patients with MM, describe the clinical presentation, treatment and evolution, and compare prepubescent and postpubescent disease. METHODS: A retrospective, descriptive, national multicenter study was undertaken of 52 cases of MM in children and adolescents. Demographic, histopathology, treatment evolution data, and survival distributions are described. RESULTS: Median age was 15 years (5-18). The tumors were often amelanotic (45%) and raised (83%), and Breslow thickness was greater than 4 mm in 35% of cases. Histological examination showed superficial spreading (n = 16) or spitzoid (n = 16) or nodular (n = 9) pattern. Twelve children (23%) were less than 10 years of age. The spitzoid histotype was more frequent in prepubescent children (seven of 12). Seventeen patients relapsed, of whom four had skin lesions initially diagnosed as benign. Ten patients died after relapse. Five-year event-free survival and overall survival were 62.7% (95% confidence interval [CI]: 45.3-76) and 75.5% (95% CI: 56.8-87.1), respectively. CONCLUSIONS: MM appears to be different in prepubescent children, of whom most had a spitzoid histotype. Diagnosis can be difficult, leading to delay in treatment. New biological tools to identify targets for treatment in MM and to differentiate spitzoid melanomas from Spitz nevi now exist. As effective targeted therapies are now available, we recommend requesting biological examination of all melanocyte-derived skin lesions in children that could be malignant.
Authors: D W Bartenstein; J M Fisher; C Stamoulis; C Weldon; J T Huang; S E Gellis; M G Liang; B Schmidt; E B Hawryluk Journal: Br J Dermatol Date: 2019-02-10 Impact factor: 9.302
Authors: Nathaniel C Holcomb; Robert-Marlo Bautista; Stuart G Jarrett; Katharine M Carter; Madeline Krentz Gober; John A D'Orazio Journal: Adv Protein Chem Struct Biol Date: 2018-12-05 Impact factor: 3.507
Authors: Anne L Ryan; Charlotte Burns; Aditya K Gupta; Ruvishani Samarasekera; David S Ziegler; Maria L Kirby; Frank Alvaro; Peter Downie; Stephen J Laughton; Siobhan Cross; Timothy Hassall; Geoff B McCowage; Jordan R Hansford; Rishi S Kotecha; Nicholas G Gottardo Journal: Front Oncol Date: 2021-04-29 Impact factor: 6.244