Childhood melanoma survival

BACKGROUND. Melanoma in childhood is uncommon. Some believe that melanoma a mong children is associated with a better prognosis than among adults. METHODS, The authors reviewed their institutional experience with melanoma in 40 patients younger than 18 years treated between 1950 and 1984. AU slid es were reviewed by a single dermatopathologist who was blinded to clinical outcomes. Long term follow-up was available for all but three patients. RESULTS. There were 26 girls and 14 boys. The median age at diagnosis was 1 5 years (range, 3-17 years). Eleven patients (28%) were younger than 12 yea rs. Fifteen patients (38%) had melanoma arise in a congenital nevus (2 had bathing trunk nevi). The most common site was the extremity (n = 23), follo wed by the trunk (n = 10) and the head and neck (n = 7). Seventeen patients (43%) initially were considered to have benign lesions, and 23 patients (5 7%) were diagnosed correctly with melanoma at initial presentation. Only 21 of 37 evaluable patients (57%) were alive at last follow-up, with a median follow-up of 18 years (range, 2-48 years). Fifteen patients (41%) died of their disease, with a median survival of 12 months (range, 6-60 months). On e patient died of breast carcinoma 14 years after treatment for melanoma. D isease free survival was 57% at 5 and 10 years. Of the 15 patients who died of disease, 12 were female (P = 0.09) and 10 had melanoma arising in a con genital nevus (P < 0.05). Five-year overall survival was 78% for patients w ho presented with localized disease (n = 23) and 30% for patients who prese nted with regional metastasis (n = 16, P < 0.001). There were no survivors among those who presented with systemic disease (n = 1). CONCLUSIONS, Children with melanoma are at significant risk of dying of the ir disease. Survival is similar to that seen among adults and depends on st age at presentation. The survival advantage observed for adult females is n ot seen among children. Cancer 1999;85:750-4. (C) 1999 American Cancer Soci ety.