Melanoma in children
At the 2024 EADV Congress, Dr Riccardo Pampena (Milan, Italy) presented important insights into the rare but serious disease of paediatric melanoma.
Biological behavior of pediatric melanoma
Pediatric melanoma often displays distinct biological behavior compared to adult forms, with specific features like spitzoid characteristics and an association with congenital nevi.
Higher frequency of Spitzoid features: in children, melanoma often presents with a spitzoid appearance, a feature initially described in a study by Amelia Salas et al. in 2014. Spitzoid lesions can look benign, making diagnosis challenging. Clinicians are advised to excise spitzoid-looking lesions, especially after the age of 12, as the risk of melanoma increases with age. Dr. Pampena presented several dermoscopic examples, showing similar lesions with spitzoid features, such as starburst patterns, global, and inverse network patterns. However, while some of these lesions were benign, others were melanomas. The key distinguishing factor was age: patients with melanoma were older than those with benign nevi.
Association with congenital nevi: congenital nevi, particularly large or giant ones, significantly increase the risk of melanoma in pediatric patients. The larger the diameter of the nevus, the higher the lifetime risk of melanoma. For instance, while the general lifetime risk for melanoma in congenital nevi is about 1%, this risk rises to 10% in large or giant congenital nevi.
Systematic review and meta-analysis of pediatric melanoma
Dr. Pampena also shared the results of a recent systematic review and meta-analysis, which included 213 articles and 1,002 pediatric melanoma cases. The data provided valuable insights into the demographics, clinical presentation, and prognosis of melanoma in children.
- Age and gender: the median age of patients was 12 years, with a slight female predominance. Melanomas were most commonly located on the limbs.
- Tumor characteristics: the median Breslow thickness was 2.3 mm, with a significant proportion of cases showing high mitotic rates and ulceration. The most common histological subtypes were superficial spreading and nodular melanomas.
- Spitzoid Melanoma: approximately 20% of cases were spitzoid melanomas. These tumors were more prevalent in younger patients, often located on the limbs or head and neck, and were typically thicker than non-spitzoid melanomas. Despite the low mortality rate, spitzoid melanomas were associated with a higher risk of nodal metastasis.
Prognostic implications
Pediatric melanoma has a complex prognosis, depending on the subtype and association with congenital nevi. For instance, melanomas associated with congenital nevi tend to be thicker and have a worse prognosis than those arising de novo. Additionally, while spitzoid melanomas have a higher risk of metastasis, their overall mortality rate is lower compared to other types.
The presentation also emphasized the prognostic differences between melanomas in the pubertal and prepubertal populations. In prepubertal children, melanoma is more often associated with congenital nevi, and spitzoid melanomas are more common, further complicating diagnosis and treatment.
Take-Home messages for clinicians in pediatric melanoma
Pediatric melanoma is rare but serious: while pediatric melanoma is rare, it is crucial not to overlook the possibility, particularly in patients with congenital nevi or atypical spitzoid lesions.
Dermoscopy is essential but not definitive: dermoscopic features alone may not be sufficient to distinguish between benign and malignant lesions, especially in children. Age and clinical context are essential factors in decision-making.
Early diagnosis and excision are critical: given the potential for spitzoid lesions to be malignant, excision and histopathological examination are necessary, particularly in older children.
Prognostic factors vary by subtype: melanomas associated with congenital nevi and spitzoid melanomas have unique prognostic profiles, necessitating careful monitoring and tailored treatment approaches.
- Orte Cano C. Chemoprevention of skin cancer: an update. EADV Congress 2024
- Wunderlicht K. EUSCAP: Risk factors for high frequency BCC. EADV Congress 2024
- Pendaries P. Euromelanoma 2025: A new campaign. EADV Congress 2024
- Blank C. Neoadjuvant treatment in melanoma. EADV Congress 2024
- Roccuzzo G. Melanoma in pregnancy. EADV Congress 2024
- Pampena R. Melanoma in children. EADV Congress 2024
- Whitaker D. Prevention and epidemiology. EADV Congress 2024
- Rocken M. Biomarker-based treatment of melanoma. EADV Congress 2024
- Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi: 10.3322/caac.21660. Epub 2021 Feb 4. PMID: 33538338.
- World Health Organization. Cancer Fact Sheets: Melanoma. WHO. 2023.
- ECIS - European Cancer Information System. Melanoma in Europe. 2020. Available at: [https://ecis.jrc.ec.europa.eu](https://ecis.jrc.ec.europa.eu)
- Marghoob AA, et al. Updated criteria for the clinical diagnosis of melanoma. JAMA Dermatol. 2021;157(1):109-116.
- Strouse JJ, et al. Pediatric melanoma: An update on diagnosis and treatment. *J Pediatr Oncol*. 2021;6(4):309-318.
- ESMO Guidelines Working Group. ESMO Clinical Practice Guidelines for melanoma. Ann Oncol. 2023;34(4):e47-e57.
- Korn EL, et al. Melanoma treatment guidelines: Early stage. Clin Adv Hematol Oncol. 2022;20(9):544-552.
- Davies MA, et al. BRAF/MEK inhibitors in metastatic melanoma. Lancet Oncol. 2023;24(7):e313-e324.
- Maeda T, et al. Pediatric melanoma: A comprehensive review. J Pediatr Hematol Oncol. 2022;44(7):405-416.
- American Cancer Society. (2023). Melanoma Skin Cancer. Available at: https://www.cancer.org/cancer/melanoma-skin-cancer.html
- Vico-Alonso C et al. Early detection of melanomas using circulating tumour-specific antibodies. Abstract 3529. EADV Congress 2024.