Advertisement

Melanoma in children and adolescents

      Abstract

      Childhood and adolescent melanoma is rare, accounting for only 1.3% for all cases of cancer in patients under the age of 20 years. However, in 15–19 year olds, melanoma accounts for up to 7% of all cancers. Review of reported cases in this age group reveals that predisposing ‘paediatric’ conditions such as a giant congenital melanocytic naevi or xeroderma pigmentosum are rarely present. Furthermore, inactivating germ-line mutations of the gene CDKN2A have only been reported in 1.5% of cases of early onset melanoma. Epidemiological studies suggest that interactions between solar exposure, development of naevi, pigmentary traits, and a family history of melanoma are the main determinants of melanoma development during the first 20 years of life. As yet, there are no available staging or treatment strategies for this group of patients so treatment recommendations are based on the adult experience. To improve our understanding of the natural history of melanoma and to identify the most appropriate therapies for young patients with this disease, practising physicians are encouraged to enroll their patients, especially those with advanced stage disease, in cooperative group trials which incorporate newer staging systems and promising therapies.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Desmond R.A
        • Soong S.J
        Epidemiology of malignant melanoma.
        Surg. Clin. North Am. 2003; 83: 1-29
        • Bevona C
        • Sober A.J
        Melanoma incidence trends.
        Dermatol Cl. 2002; 20: 589-595
        • MacKie R.M
        • Bray C.A
        • Hole D.J
        • et al.
        Incidence of and survival from malignant melanoma in Scotland.
        Lancet. 2002; 360: 587-591
        • Siskind V
        • Aitken J
        • Green A
        • Martin N
        Sun exposure and interaction with family history in risk of melanoma, Queensland, Australia.
        Int. J. Cancer. 2002; 97: 90-95
        • Houghton A.N
        • Polsky D
        Focus on melanoma.
        Cancer Cell. 2002; 2: 275-278
        • Hamre M.R
        • Chuba P
        • Bakhshi S
        • Thomas R
        • Severson R.K
        Cutaneous melanoma in childhood and adolescence.
        Pediatr. Hematol. Oncol. 2002; 19: 309-317
        • Gloecker Ries L.A
        • Smith M.A
        • Gurney J.G
        • et al.
        Cancer Incidence and Survival among Children and Adolescents: United States SEER Program 1975–1995. SEER Program Pub. No. 99-4649.
        National Cancer Institute, Bethesda, MD1999
        • Berg P
        • Lindelof B
        Differences in malignant melanoma between children and adolescents. A 35-year epidemiological study.
        Arch. Dermatol. 1997; 133: 295-297
        • Stiller C
        Epidemiology of cancer in adolescents.
        Med. Pediatr. Oncol. 1997; 39: 149-155
        • Bleyer W.A
        Cancer in older adolescents and young adults.
        Med. Pediatr. Oncol. 2002; 38: 1-10
        • Richardson S.K
        • Tannous Z.S
        • Mihm Jr., M.C
        Congenital and infantile melanoma.
        J. Am. Acad. Dermatol. 2002; 47: 77-90
        • Ceballos P.I
        • Ruiz-Maldonado R
        • Mihm Jr., M.C
        Melanoma in children.
        N. Engl. J. Med. 1995; 332: 656-662
        • Makkar H.S
        • Frieden I.J
        Congenital melanocytic nevi.
        Curr. Opin. Pediatr. 2002; 14: 397-403
        • Bittencourt F.V
        • Marghoob A.A
        • Kopf A.W
        • Koenig K.L
        • Bart R.S
        Large congenital melanocytic nevi and the risk for development of malignant melanoma and neurocutaneous melanocytosis.
        Pediatrics. 2000; 106: 736-741
        • Giam Y.C
        • Williams M.L
        • Leboit P.E
        • Orlow S.J
        • Eichenfield L.F
        • Frieden I.J
        Neonatal erosions and ulcerations in giant congenital melanocytic nevi.
        Pediatr. Dermatol. 1999; 16: 354-358
        • Ruiz-Maldonado R
        • Tamayo L
        • Laterza A.M
        • Duran C
        Giant pigmented nevi.
        J. Pediatr. 1991; 120: 906-911#
        • Egan C.L
        • Oliveria S.A
        • Elenitsas R
        • Hanson J
        • Halpern A.C
        Cutaneous melanoma risk and phenotypic changes in large congenital nevi.
        J. Am. Acad. Dermatol. 1998; 39: 923-932
        • Kadonga J.N
        • Frieden I.J
        Neurocutaneous melanosis.
        J. Am. Acad. Dermatol. 1991; 24: 747-755
        • DeDavid M
        • Orlow S.J
        • Provost N
        • et al.
        Neurocutaneous melanosis.
        J. Am. Acad. Dermatol. 1996; 35: 529-538
        • Foster R.D
        • Williams M.L
        • Barkovich A.J
        • et al.
        Giant congenital melanocytic nevi.
        Plast. Reconstr. Surg. 2001; 107: 933-941
        • Koh H.K
        Cutaneous melanoma.
        N. Engl. J. Med. 1991; 325: 171-182
        • Bootsma D
        • Kramer K.H
        • Cleaver J.E
        • Hoeijmakers J.H
        Nucleotide excison repair syndromes: Xeroderma Pigmentosum, Cockayne Syndrome and trichothiodystrophy.
        in: Scriver C.R Beaudet A.L Valle D Sly W.S The Metabolic and Molecular Bases of Inherited Disease. McGraw Hill, New York2001: 677-703
        • van Brabant A.J
        • Stan R
        • Ellis N.A
        DNA helicases, genomic instability, and human genetic disease.
        Annu. Rev. Genomics Hum. Genet. 2000; 1: 409-459
        • Lindenbaum Y
        • Dickson D
        • Rosenbaum P
        • Kraemer K
        • Robbins I
        • Rapin I
        Xeroderma pigmentosum/cockayne syndrome complex.
        Eur. J. Paediatr. Neurol. 2001; 5: 225-242
        • Lambert W.C
        • Kuo H.R
        • Lambert M.W
        Xeroderma pigmentosum.
        Dermatol Clinics. 1995; 13: 169-209
        • Kraemer K.H
        • Lee M.M
        • Scotto J
        Xeroderma pigmentosum. Cutaneous, ocular, and neurologic abnormalities in 830 published cases.
        Arch. Dermatol. 1987; 123: 241-250
        • Euvrard S
        • Kanitakis J
        • Claudy A
        Skin cancers after organ transplantation.
        N. Engl. J. Med. 2003; 348: 1681-1691
        • Berg D
        • Otley C.C
        Skin cancer in organ transplant recipients.
        J. Am. Acad. Dermatol. 2002; 47: 1-17
        • Curtis R.E
        • Rowlings P.A
        • Deeg H.J
        • et al.
        Solid cancers after bone marrow transplantation.
        N. Engl. J. Med. 1997; 336: 897-904
        • Duvic M
        • Lowe L
        • Rapini R.P
        • Rodriguez S
        • Levy M.L
        Eruptive dysplastic nevi associated with human immunodeficiency virus infection.
        Arch. Dermatol. 1989; 125: 397-401
        • Grob J.J
        • Bastuji-Garin S
        • Vaillant L
        • et al.
        Excess of nevi related to immunodeficiency.
        J. Invest. Dermatol. 1996; 107: 694-697
        • Rasokat H
        • Steigleder G.K
        • Bendick C
        • Muller S
        • Meller M
        [Malignant melanoma and HIV infection].
        Z. Hautkr. 1989; 64: 587
        • Calista D
        Five cases of melanoma in HIV positive patients.
        Eur. J. Dermatol. 2001; 11: 446-449
        • Baird E.A
        • McHenry P.M
        • MacKie R.M
        Effect of maintenance chemotherapy in childhood on numbers of melanocytic naevi.
        Br. Med. J. 1992; 305: 799-801
        • de Wit P.E
        • de Vaan G.A
        • de Boo T.M
        • Lemmens W.A
        • Rampen F.H
        Prevalence of naevocytic naevi after chemotherapy for childhood cancer.
        Med. Pediatr. Oncol. 1990; 18: 336-338
        • Carli P
        • Naldi L
        • Lovati S
        • La Vecchia C
        The density of melanocytic nevi correlates with constitutional variables and history of sunburns.
        Int. J. Cancer. 2002; 101: 375-379
        • Kefford R.F
        • Newton Bishop J.A
        • Bergman W
        • Tucker M.A
        Counseling and DNA testing for individuals perceived to be genetically predisposed to melanoma.
        J. Clin. Oncol. 1999; 17: 3245-3251
        • Bishop D.T
        • Demenais F
        • Goldstein A.M
        • et al.
        Geographical variation in the penetrance of CDKN2A mutations for melanoma.
        J. Natl. Cancer Inst. 2002; 94: 894-903
        • Monzon J
        • Liu L
        • Brill H
        • et al.
        CDKN2A mutations in multiple primary melanomas.
        N. Engl. J. Med. 1998; 338: 879-887
        • Tucker M.A
        • Fraser M.C
        • Goldstein A.M
        • et al.
        A natural history of melanomas and dysplastic nevi.
        Cancer. 2002; 94: 3192-3209
        • Tsao H
        • Zhang X
        • Kwitkiwski K
        • Finkelstein D.M
        • Sober A.J
        • Haluska F.G
        Low prevalence of germline CDKN2A and CDK4 mutations in patients with early-onset melanoma.
        Arch. Dermatol. 2000; 136: 1118-1122
        • Youl P
        • Aitken J
        • Hayward N
        • et al.
        Melanoma in adolescents.
        Int. J. Cancer. 2002; 98: 92-98
        • Whiteman D.C
        • Milligan A
        • Welch J
        • Green A.C
        • Hayward N.K
        Germline CDKN2A mutations in childhood melanoma.
        J. Natl. Cancer Inst. 1997; 89: 1460
        • Sahin S
        • Levin L
        • Kopf A.W
        • et al.
        Risk of melanoma in medium-sized congenital melanocytic nevi.
        J. Am. Acad. Dermatol. 1998; 39: 428-433
        • Swerdlow A.J
        • English J.S
        • Qiao Z
        The risk of melanoma in patients with congenital nevi.
        J. Am. Acad. Dermatol. 1995; 32: 595-599
        • Darlington S
        • Siskind V
        • Green L
        • Green A
        Longitudinal study of melanocytic nevi in adolescents.
        J. Am. Acad. Dermatol. 2002; 46: 715-722
        • Whiteman D.C
        • Valery P
        • McWhirter W
        • Green A.C
        Risk factors for childhood melanoma in Queensland, Australia.
        Int. J. Cancer. 1997; 70: 26-31
        • Tucker M.A
        • Halpern A
        • Holly E.A
        • et al.
        Clinically recognized dysplastic nevi. A central risk factor for cutaneous melanoma.
        JAMA. 1997; 277: 1439-1444
        • Goldstein A.M
        • Fraser M.C
        • Clark Jr., W.H
        • Tucker M.A
        Age at diagnosis and transmission of invasive melanoma in 23 families with cutaneous malignant melanoma/dysplastic nevi.
        J. Natl. Cancer Inst. 1994; 86: 1385-1390
        • Barnhill R.L
        • Flotte T.J
        • Fleischli M
        • Perez-Atayde A
        Cutaneous melanoma and atypical Spitz tumors in childhood.
        Cancer. 1995; 76: 1833-1845
        • Gelbard S.N
        • Tripp J.M
        • Marghoob A.A
        • et al.
        Management of Spitz nevi.
        J. Am. Acad. Dermatol. 2002; 47: 224-230
        • Lohmann C.M
        • Coit D.G
        • Brady M.S
        • Berwick M
        • Busam K.J
        Sentinel lymph node biopsy in patients with diagnostically controversial spitzoid melanocytic tumors.
        Am. J. Surg. Pathol. 2002; 26: 47-55
        • Boddie Jr., A.W
        • Smith Jr., J.L
        • McBride C.M
        Malignant melanoma in children and young adults.
        South Med. J. 1978; 71: 1074-1078
        • Saenz N.C
        • Saenz-Badillos J
        • Busam K
        • LaQuaglia M.P
        • Corbally M
        • Brady M.S
        Childhood melanoma survival.
        Cancer. 1999; 85: 750-754
        • Melnik M.K
        • Urdaneta L.F
        • Al Jurf A.S
        • Foucar E
        • Jochimsen P.R
        • Soper R.T
        Malignant melanoma in childhood and adolescence.
        Am. Surg. 1986; 52: 142-147
        • Hamre M.R
        • Chuba P
        • Bakhshi S
        • Thomas R
        • Severson R.K
        Cutaneous melanoma in childhood and adolescence.
        Pediatr. Hematol. Oncol. 1999; 19: 309-317
        • Balch C.M
        Cutaneous melanoma.
        Semin. Surg. Oncol. 1992; 8: 400-414
        • Rao B.N
        • Hayes F.A
        • Pratt C.B
        • et al.
        Malignant melanoma in children.
        J. Pediatr. Surg. 1990; 25: 198-203
        • Balch C.M
        • Buzaid A.C
        • Soong S.J
        • et al.
        Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma.
        J. Clin. Oncol. 2001; 19: 3635-3648
        • Kogut K.A
        • Fleming M
        • Pappo A.S
        • Schropp K.P
        Sentinel lymph node biopsy for melanoma in young children.
        J. Pediatr. Surg. 2000; 35: 965-966
        • Neville H.L
        • Andrassy R.J
        • Lally K.P
        • Corpron C
        • Ross M.I
        Lymphatic mapping with sentinel node biopsy in pediatric patients.
        J. Pediatr. Surg. 2000; 35: 961-964
        • Balch C.M
        • Ross M.I
        Sentinel lymphadenectomy for melanoma—is it a substitute for elective lymphadenectomy?.
        Ann. Surg. Oncol. 1999; 6: 416-417
        • Gershenwald J.E
        • Tseng C.H
        • Thompson W
        • et al.
        Improved sentinel lymph node localization in patients with primary melanoma with the use of radiolabeled colloid.
        Surgery. 1998; 124: 203-210
        • Gershenwald J.E
        • Thompson W
        • Mansfield P.F
        • et al.
        Multi-institutional melanoma lymphatic mapping experience.
        J. Clin. Oncol. 1999; 17: 976-983
        • Buzaid A.C
        • Sandler A.B
        • Mani S
        • et al.
        Role of computed tomography in the staging of primary melanoma.
        J. Clin. Oncol. 1993; 11: 638-643
        • Kaste S.C
        • Pappo A.S
        • Jenkins III, J.J
        • Pratt C.B
        Malignant melanoma in children.
        Pediatr. Radiol. 1996; 26: 800-805
        • Acland K.M
        • Healy C
        • Calonje E
        • et al.
        Comparison of positron emission tomography scanning and sentinel node biopsy in the detection of micrometastases of primary cutaneous malignant melanoma.
        J. Clin. Oncol. 2001; 19: 2674-2678
        • Cobben D.C
        • Koopal S
        • Tiebosch A.T
        • et al.
        New diagnostic techniques in staging in the surgical treatment of cutaneous malignant melanoma.
        Eur. J. Surg. Oncol. 2002; 28: 692-700
        • Longo M.I
        • Lazaro P
        • Bueno C
        • Carreras J.L
        • Montz R
        Fluorodeoxyglucose-positron emission tomography imaging versus sentinel node biopsy in the primary staging of melanoma patients.
        Dermatol. Surg. 2003; 29: 245-248
        • Balch C.M
        • Soong S.J
        • Smith T
        • et al.
        Long-term results of a prospective surgical trial comparing 2 cm vs. 4 cm excision margins for 740 patients with 1–4 mm melanomas.
        Ann. Surg. Oncol. 2001; 8: 101-108
        • Harris M.N
        • Shapiro R.L
        • Roses D.F
        Malignant melanoma. Primary surgical management (excision and node dissection) based on pathology and staging.
        Cancer. 1995; 75: 715-725
        • Shen J
        • Wallace A.M
        • Bouvet M
        The role of sentinel lymph node biopsy for melanoma.
        Semin. Oncol. 2002; 29: 341-352
        • Agarwala S.S
        • Kirkwood J.M
        Update on adjuvant interferon therapy for high-risk melanoma.
        Oncology (Huntingt.). 2002; 16: 1177-1187
        • Kirkwood J.M
        • Ibrahim J.G
        • Sosman J.A
        • et al.
        High-dose interferon alfa-2b significantly prolongs relapse-free and overall survival compared with the GM2-KLH/QS-21 vaccine in patients with resected stage IIB-III melanoma.
        J. Clin. Oncol. 2001; 19: 2370-2380
        • Kirkwood J.M
        • Strawderman M.H
        • Ernstoff M.S
        • Smith T.J
        • Borden E.C
        • Blum R.H
        Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma.
        J. Clin. Oncol. 1996; 14: 7-17
        • Kirkwood J.M
        • Ibrahim J.G
        • Sondak V.K
        • et al.
        High- and low-dose interferon alfa-2b in high-risk melanoma.
        J. Clin. Oncol. 2000; 18: 2444-2458
        • Boddie A.W
        • Cangir A
        Adjuvant and neoadjuvant chemotherapy with dacarbazine in high-risk childhood melanoma.
        Cancer. 1987; 15: 1720-1723
        • Hayes F.A
        • Green A.A
        Malignant melanoma.
        J. Clin. Oncol. 1984; 2: 1229-1234
        • Pappo A.S
        • Kaste S.C
        • Rao B.N
        • Pratt C.B
        Childhood melanoma.
        in: Balch C.M Houghton A.N Sober A.J Soong S.J Cutaneous Melanoma. Quality Medical Publishing, St Louis, MO1998: 175-186
        • Rosenberg S.A
        • Yang J.C
        • Topalian S.L
        • et al.
        Treatment of 283 consecutive patients with metastatic melanoma or renal cell cancer using high-dose bolus Interleukin 2.
        JAMA. 1994; 271: 907-913
        • Ribeiro R.C
        • Rill D
        • Roberson P.K
        • et al.
        Continuous infusion of interleukin-2 in children with refractory malignancies.
        Cancer. 1993; 72: 623-628
        • Bauer M
        • Reaman G.H
        • Hank J.A
        • et al.
        A phase II trial of human recombinant interleukin-2 administered as a 4-day continuous infusion for children with refractory neuroblastoma, non-Hodgkin's lymphoma, sarcoma, renal cell carcinoma, and malignant melanoma. A Childrens Cancer Group study.
        Cancer. 1995; 75: 2959-2965
        • Eton O
        • Legha S.S
        • Bedikian A.Y
        • et al.
        Sequential biochemotherapy versus chemotherapy for metastatic melanoma.
        J. Clin. Oncol. 2002; 20: 2045-2052
        • Rodriguez-Galindo C
        • Pappo A.S
        • Kaste S.C
        • et al.
        Brain metastases in children with melanoma.
        Cancer. 1997; 79: 2440-2445
        • Geller A.C
        • Cantor M
        • Miller D.R
        • et al.
        The Environmental Protection Agency's National SunWise School Program.
        J. Am. Acad. Dermatol. 2002; 46: 683-689
        • Geller A.C
        • Colditz G
        • Oliveria S
        • et al.
        Use of sunscreen, sunburning rates, and tanning bed use among more than 10 000 US children and adolescents.
        Pediatrics. 2002; 109: 1009-1014
        • Schmid-Wendtner M.H
        • Berking C
        • Baumert J
        • et al.
        Cutaneous melanoma in childhood and adolescence.
        J. Am. Acad. Dermatol. 2002; 46: 874-879
        • Gibbs P
        • Moore A
        • Robinson W
        • Walsh P
        • Golitz L
        • Gonzalez R
        Pediatric melanoma.
        J. Pediatr. Hematol. Oncol. 2000; 22: 428-432
        • Milton G.W
        • Shaw H.M
        • Thompson J.F
        • McCarthy W.H
        Cutaneous melanoma in childhood.
        Australas. J. Dermatol. 1997; 38: S44-S48
        • Davidoff A.M
        • Cirrincione C
        • Seigler H.F
        Malignant melanoma in children.
        Ann. Surg. Oncol. 1994; 1: 278-282
        • Tate P.S
        • Ronan S.G
        • Feucht K.A
        • Eng A.M
        • Das Gupta T.K
        Melanoma in childhood and adolescence.
        J. Pediatr. Surg. 1993; 28: 217-222
        • Temple W.J
        • Mulloy R.H
        • Alexander F
        • Marx L.H
        • Jenkins M
        • Jerry L.M
        Childhood melanoma.
        J. Pediatr. Surg. 1991; 26: 135-137
        • Merlino G
        • Noonan F.P
        Modeling gene-environment interactions in malignant melanoma.
        Trends Mol. Med. 2003; 9: 102-108