Treatment outcomes in pediatric melanoma-Are there benefits to specialized care?
OBJECTIVE
The purpose of this study was to evaluate the impact of hospital specialization on survival in pediatric melanoma.


METHODS
We reviewed all patients under 18years old with cutaneous melanoma evaluated at MD Anderson Cancer Center, a National Cancer Institute (NCI)-designated center, from 2000 to 2014. We compared overall survival (OS) and disease-free survival (DFS) between patients who underwent all treatments at MDACC (Group A, n=146) and those who underwent initial surgical treatment at a non-NCI center (Group B, n=58). Kaplan-Meier survival curves were compared using the log-rank test.


RESULTS
Group A patients had significantly better OS and DFS (both p<0.001). Five-year OS was 97% (95% CI 92%-99%) in Group A versus 88% (95% CI 74%-94%) in Group B. Group survival differences were most notable in Stage 3 and 4 patients. Group A patients presenting with stage III or IV disease had a 5-year OS rate of 91.2% (95% CI 75.1%-97.1%) compared to 80.8% (95% CI 59.8%-91.5%) in Group B. The DFS rate was 94.4% (95% CI 88.5%-97.3%) in Group A versus 77.2% (95% CI 62.5%-86.7%) in Group B.


CONCLUSIONS
Surgical treatment at a comprehensive cancer center may improve outcomes for pediatric melanoma especially for patients presenting with later stage disease.


METHODS
Case-control study: Level III.
Department of Pediatric Surgery, The McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, Suite 5.258, Houston, TX 77030.
Benjamin
B
Freemyer
Department of Pediatric Surgery, The McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, Suite 5.258, Houston, TX 77030.
Emma
E
Hamilton
Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler, Floor 4, FCT4.600, Houston, TX 77030.
Carla L
CL
Warneke
Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX 77030.
Ali M
AM
Ali
Department of Pediatrics, Children's Cancer Hospital at the University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 0087, Houston, TX 77030.
Cynthia
C
Herzog
Department of Pediatric Surgery, The McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, Suite 5.258, Houston, TX 77030; Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX 77030.
Andrea
A
Hayes-Jordan
Department of Pediatric Surgery, The McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, Suite 5.258, Houston, TX 77030; Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX 77030. Electronic address: MAustin@mdanderson.org.
Mary
M
Austin
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009367:Neoplasm Staging; D012878:Skin Neoplasms; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome; D000096142:Cutaneous Malignant Melanoma
Outcomes; Pediatric melanoma; Specialization; Survival