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443 paediatric cases of malignant melanoma registered with the German Central Malignant Melanoma Registry between 1983 and 2011

Ines B. Brecht, Claus Garbe, Olaf Gefeller, Annette Pfahlberg, Jürgen Bauer, Thomas K. Eigentler, Sonja Offenmueller, Dominik T. Schneider, Ulrike Leiter

European Journal of Cancer, Volume 51, Issue 7, May 2015, Pages 861-868

Editors’ comment: Dr. Paolo Ascierto

Melanoma is extremely rare in children; for this reason, little is known about biology and clinical behavior of pediatric malignant melanoma. This is an interesting prospective analysis performed on 443 pediatric patients with melanoma registered in the German Central Malignant Melanoma Registry between 1983 and 2011 in order to evaluate the characteristics of the disease and prognosis. The analysis don’t show significant differences neither regarding diagnostic methods or the prognosis nor the therapeutic approach of pediatric melanoma, suggesting that should be used in children the same clinical approach used for adults.

Background

Malignant melanoma is a very rare paediatric tumour. This study was performed in order to understand clinical features and prognosis of malignant melanoma in children and adolescents.

Methods

443 patients 618 years of age with malignant melanoma were prospectively registered with the German Central Malignant Melanoma Registry between 1983 and 2011. Cases were collected from 58 participating centres. 276 paediatric cases with a follow-up
>3 months were evaluated for survival probabilities and prognostic factors by Kaplan–Meier method.

Results

Age of diagnosis ranged from 3 months to 18 years (median age 16 years). The male to female ratio was 0.8 (202 male, 240 female). Most melanoma were located at the trunk (n = 195) and the lower extremity (n = 114). Patients with >3 months of follow-up (median
55 months) showed an overall survival (OS) of 94.8% in 5 years. Survival according to tumour stage was 98.5% for stage I (n = 190), 91.1% for stage II (n = 39) and 53.0% for stage III/IV tumours (n = 11). Worse outcome was seen in patients with nodular melanoma (OS 77.9%, n = 42) compared to superficial spread histotype (OS 100%, n = 138) or other histotype (OS 96.9%, n = 88) (p < 0.0001), in case of thicker tumours (Clark level IV or V, OS 87.1%,