title: Pediatric and Adolescent Melanoma: A National Cancer Data Base Update.
abstract: Studies suggest that the biology of pediatric and adolescent melanoma differs from that of adult disease. We report the largest series to date examining the natural history of pediatric and adolescent melanoma. We aim to elucidate the natural history of pediatric and adolescent melanoma and to examine the appropriateness of diagnostic and therapeutic modalities developed for adults and that are currently being used in children.
  
  
  
  A retrospective cohort study was conducted of patients with an index diagnosis of cutaneous non-metastatic melanoma from 1998 to 2011 using the National Cancer Data Base (NCDB; n = 420,416). Three age-based cohorts were analyzed: 1-10 years (pediatric), 11-20 years (adolescent), and ≥21 years (adult). Multivariate analyses were used to identify factors associated with overall survival (OS).
  
  
  
  Pediatric melanoma patients have longer OS than their adolescent (hazard ratio [HR] 0.50, 95 % CI 0.25-0.98) and adult counterparts (HR 0.11, 95 % CI 0.06-0.21). Adolescents have longer OS than adults. No difference was found in OS in pediatric patients who are node-positive versus node-negative. In pediatric patients, sentinel lymph node biopsy and completion lymph node dissection are not associated with increased OS. In adolescents, nodal positivity is a significant negative prognostic indicator (HR 4.82, 95 % CI 3.38-6.87).
  
  
  
  Age-based differences in melanoma outcomes warrant different considerations for diagnostic and therapeutic approaches in each group in order to maximize quality of life while minimizing complications and costs. Prospective, multicenter studies should evaluate the role of diagnostic procedures for pediatric patients.
authors.affiliation: Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Lorimer
authors.affiliation: Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: White
authors.affiliation: Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA.
authors.forename: Kendall
authors.initials: K
authors.lastname: Walsh
authors.affiliation: Department of Biostatistics, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA.
authors.forename: Yimei
authors.initials: Y
authors.lastname: Han
authors.affiliation: Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA.
authors.forename: Russell C
authors.initials: RC
authors.lastname: Kirks
authors.affiliation: Department of Biostatistics, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA.
authors.forename: James
authors.initials: J
authors.lastname: Symanowski
authors.affiliation: Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA.
authors.forename: Meghan R
authors.initials: MR
authors.lastname: Forster
authors.affiliation: Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA.
authors.forename: Terry
authors.initials: T
authors.lastname: Sarantou
authors.affiliation: Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Salo
authors.affiliation: Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA. joshua.hill@carolinas.org.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Hill
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality* / Q000556:secondary* / Q000628:therapy; D009367:Neoplasm Staging; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D055815:Young Adult