High-risk surgically resected pediatric melanoma and adjuvant interferon therapy.
BACKGROUND
Pediatric patients with high-risk surgically resected melanoma are at risk for relapse, yet little is known about these young patients and how they tolerate high-dose interferon therapy.


METHODS
We reviewed medical records of patients (< or =18 years) with high-risk melanoma referred to the University of Michigan Pediatric Hematology-Oncology service between January 1989 and July 2003.


RESULTS
Fourteen patients were identified with high-risk resected melanoma. The median age at diagnosis was 8.5 years. The median time to establish diagnosis was 9 months. Primary lesions were diagnosed as unequivocal melanoma, atypical epithelioid melanocytic proliferations, or atypical Spitz tumor with indeterminate malignant potential. Twelve patients had a positive sentinel lymph node (SLN) biopsy or a palpable regional lymph node and underwent regional lymph node dissection (LND). Two patients with unequivocal melanoma with Breslow depth >4 mm had negative SLN biopsies. Twelve patients received adjuvant high-dose interferon. The following toxicities were observed: constitutional symptoms, gastrointestinal symptoms, depression or neuropsychiatric symptoms, myelosuppression, elevated AST or ALT, hypothyroidism, and hypertension. Grade 3 or 4 toxicities were uncommon with exception of neutropenia, resulting in modification of therapy in one patient. All patients are alive and free of disease at follow-up (median 24.5 months).


CONCLUSIONS
Invasive melanoma can occur in very young children. Despite early signs of malignancy, there is often a delay in diagnosis. Histologically, diagnosis may be difficult because of overlap with Spitz nevi. Pediatric patients tolerated adjuvant high-dose interferon well and may be less likely than adults to require therapy modification secondary to toxicities.
Chao
Mwe Mwe
MM
Department of Pediatric Hematology-Oncology, University of Michigan Health System, Ann Arbor, Michigan 48109-0936, USA. mmchao@umich.edu
Schwartz
Jennifer L
JL
Wechsler
Daniel S
DS
Thornburg
Courtney D
CD
Griffith
Kent A
KA
Williams
James A
JA
D000293:Adolescent; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007372:Interferons / Q000627:therapeutic use* / Q000633:toxicity; D008297:Male; D008545:Melanoma / Q000150:complications / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D012189:Retrospective Studies; D015996:Survival Rate
D007372:Interferons