title: The unique clinical characteristics of melanoma diagnosed in children.
abstract: BACKGROUND
  Studies have demonstrated a higher rate of nodal metastases in melanoma of childhood, but there is controversy about the overall prognosis relative to adults. We describe a large single-institution experience with pediatric melanoma and assess prognostic characteristics.
  
  
  METHODS
  Retrospective review identified 126 patients diagnosed with melanoma at <21 years of age and referred for treatment from 1986 to 2011. Atypical lesions were excluded. Clinicopathologic characteristics were correlated with sentinel lymph node (SLN) status and outcomes.
  
  
  RESULTS
  SLN biopsy was positive in 18 of 62 cases (29 %). Increasing Breslow thickness correlated with a positive SLN (p < 0.05). After a median follow-up of 5 years, there were 27 recurrences and 20 deaths. Positive SLN patients had significantly worse recurrence-free survival (RFS, p < 0.05) and significantly worse melanoma-specific survival (MSS, p = 0.05) compared with negative SLN patients. The 5-year RFS and MSS for positive SLN patients were 59.5 and 77.8 %, compared with 93.7 and 96.8 % for negative SLN patients. Recurrences and melanoma-related deaths were often seen beyond 5 years. No deaths have occurred in patients <12 years, but 9.1 % of patients 12-17 years and 17.2 % of patients 18-20 years died from melanoma (p = 0.291).
  
  
  CONCLUSIONS
  Children with melanoma have higher rates of SLN metastases (29 %) than adults with comparable melanomas. Despite the higher incidence of nodal metastases, survival is equal to or better than what is reported for adults. However, long-term follow-up is necessary in this population since recurrences and deaths are often seen beyond 5 years.
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Han
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Zager
authors.forename: Gang
authors.initials: G
authors.lastname: Han
authors.forename: Suroosh S
authors.initials: SS
authors.lastname: Marzban
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Puleo
authors.forename: Amod A
authors.initials: AA
authors.lastname: Sarnaik
authors.forename: Damon
authors.initials: D
authors.lastname: Reed
authors.forename: Jane L
authors.initials: JL
authors.lastname: Messina
authors.forename: Vernon K
authors.initials: VK
authors.lastname: Sondak
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D015996:Survival Rate; D055815:Young Adult