Melanoma in Children

Summary and Comment |
May 18, 2007

Melanoma in Children

  1. Mary Wu Chang, MD

It’s inherently different from melanoma in adults.

  1. Mary Wu Chang, MD

Melanoma is rare in children, but its incidence appears to be rising. A recent report based on the Surveillance, Epidemiology, and End Results (SEER) database confirms an increased incidence of approximately 2.9% per year in children from 1973 to 2001. Melanoma in adolescents also appears to be rising, not only in the U.S. but in Sweden too.

The National Cancer Data Base collects data on incident cancer from U.S. hospital-based tumor registries. Data from 1985 through 2003 were reviewed to elucidate demographics, presentation, and survival of children (age range, 1–19 years) with melanoma. Data for patients ages 20 to 24 were used for comparison.

Of 3158 patients ages 1 to 19, 96.3% had cutaneous melanoma, 3.0% had ocular melanoma, and 0.7% had an unknown primary tumor. Cutaneous melanoma was more common in girls (55.5%) and in patients older than 10 (90.5%). Younger children with melanoma were more likely to be nonwhite and male and to present with a primary tumor of the head or neck and with regional or distant metastases. Poorer survival was associated with higher stage and younger age. In contrast to survival in patients ages 20 to 24, survival in children and teenagers with localized invasive melanoma was not related to tumor thickness. The authors conclude that melanoma in children and teenagers differs from melanoma in young adults, but understanding why requires further study.

Comment

The female and nonwhite predominance in these patients suggest that inherent biologic differences exist in childhood melanoma compared with adult melanoma. Poorer survival in young children may be due, in part, to delayed diagnosis. From a clinician’s standpoint, limitations of the study include the facts that the patients were hospital-based and that pathological diagnosis was not reviewed. In addition, the database did not capture information on whether melanoma developed de novo, from an acquired nevus, or from a congenital melanocytic nevus. There were also no data on skin phototype, family history, comorbidities, or other predisposing factors. Nonetheless, melanoma in children is not as rare as we have historically believed.

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