Does melanoma behave differently in younger children than in adults? A retrospective study of 33 cases of childhood melanoma from a single institution.

Objective. We retrospectively analyzed the data from 33 patients who were up to 14 years of age and treated for cutaneous melanoma at the Istituto Na- zionale Tumori, Milan, over a 25-year period. Methods. Primary lesions were amelanotic in half of the cases and raised in 73%. Lower extremities were the most common primary sites. Histologically, 9 cases were classified as nodular type, and median thickness was 2.5 mm. Nine children had nodal involvement at diagnosis, 2 in-transit metastases, and 1 distant spread. Surgery was the mainstay of treatment; 9 patients underwent lymph node dissection, 3 received chemotherapy, and 2 received radiotherapy. Results. With a median follow-up of 122 months, 5-year event-free survival and overall survival were 60% and 70%, respectively. Age seemed to correlate with sur- vival, event-free survival being 90% in children under 10 and 47% in older patients, although the initial microstag- ing seemed worse in the former. Conclusion. By comparison with adult cases, child- hood melanoma can have a higher percentage of atypical clinical features (amelanotic and raised lesions), nodular histotype, and thick lesions. Although we have no data to support any suggestion of biological differences between young children and adolescents or adults, our findings give the impression that melanoma behaves better in the younger age group. Pediatrics 2005;115:000; age, children, cutaneous melanoma, pediatric rare tumors, prognostic factors.