title: Does melanoma behave differently in younger children than in adults? A retrospective study of 33 cases of childhood melanoma from a single institution.
abstract: OBJECTIVE
  To ascertain whether childhood melanoma presents any peculiar clinical features or differences in prognosis with respect to adults, we retrospectively analyzed the data from 33 patients who were up to 14 years of age and treated for cutaneous melanoma at the Istituto Nazionale 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 survival, event-free survival being 90% in children under 10 and 47% in older patients, although the initial microstaging seemed worse in the former.
  
  
  CONCLUSIONS
  By comparison with adult cases, childhood 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 differently in the younger age group.
authors.affiliation: Pediatric Oncology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy. andrea.ferrari@istitutotumori.mi.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferrari
authors.forename: Aldo
authors.initials: A
authors.lastname: Bono
authors.forename: Marzia
authors.initials: M
authors.lastname: Baldi
authors.forename: Paola
authors.initials: P
authors.lastname: Collini
authors.forename: Michela
authors.initials: M
authors.lastname: Casanova
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Pennacchioli
authors.forename: Monica
authors.initials: M
authors.lastname: Terenziani
authors.forename: Ilaria
authors.initials: I
authors.lastname: Marcon
authors.forename: Mario
authors.initials: M
authors.lastname: Santinami
authors.forename: Cesare
authors.initials: C
authors.lastname: Bartoli
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome