Juvenile malignant melanoma.

Malignant melanoma in children and adolescents is a rare phenomenon. During a retrospective computer-aided chart review, 78 patients less than 20 years of age were identified who had the diagnosis of malignant melanoma. This accounted for 1.8 per cent of all the melanomas registered at the University Melanoma Clinic. Fifty-one per cent were females, and all the patients were white. Most of the lesions were found on the primary areas of the trunk and extremities. Sixty-seven per cent of the melanomas were of the superficial spreading type, and 82 per cent were invasive to Clark level III and IV. The range of tumor thickness was 0.32 to 5.22 millimeters, with a mean of 1.76 millimeters. Similar population characteristics were noted in the adult and juvenile populations. Controlling for the two most powerful prognostic factors for Stage I melanoma, that is, ulceration and tumor thickness, the actuarial survival times between the two population groups were similar. The median survival times in the adult and juvenile population were 12.9 and 11.9 years, respectively (p = 0.54). There was a trend toward a shorter disease-free interval in the juvenile population. The five year disease-free interval was 65 per cent for adults with melanoma compared with 57 per cent for juveniles with malignant melanoma (p = 0.16). Multiple regression analysis failed to reveal age less than 20 years to be an independent prognostic factor for the development of metastases or over-all survival time. Recurrent disease was observed in 46.2 per cent of juveniles with melanoma who were initially Stage I at diagnosis. Eighty per cent of the relapses occurred in either the local skin or regional lymph nodes. Although malignant melanoma is rare in populations of patients younger than 20 years of age, clinicians should be aware that melanoma does occur in juveniles. With an aggressive approach to surgical therapy, survival rate is comparable with that of the adult population.

Duke Scholars

Author Hilliard Foster Seigler Surgical Oncology