C. S. Lau1,2, K. Kulkarni2, R. S. Chamberlain1,2,3 1Saint Barnabas Medical Center,Surgery,Livingston, NJ, USA 2St. George’s University School Of Medicine,St. George’s, St. George’s, Grenada 3Rutgers University,Surgery,Newark, NEW JERSEY, USA
Introduction: The incidence of cutaneous melanoma has steadily risen over the last decade, with over one million people in the United States living with a melanoma diagnosis. Melanoma is the most common form of skin cancer among pediatric patients, accounting for 7% of pediatric cancers. This study examines a large cohort of pediatric melanoma patients to identify demographic, pathologic, and clinical factors which affect clinical outcomes and survival.
Methods: Data on 326,278 patients with malignant cutaneous melanoma was abstracted from the Surveillance, Epidemiology and End Result (SEER) database (1973-2013). Children were defined as age ‘0-12’, adolescents as ‘13-19’ and adults as ‘≥20’. Standard statistical analyses were performed.
Results: Among 326,278 melanoma patients, 431 were children, 2,093 were adolescents and 323,754 were adults. The majority of childhood and adolescent melanomas occurred in females (60.3% and 57.9%), whereas a majority of adult melanoma occurred in males (57.0%), p<0.01. Children most commonly presented with melanomas of the head and neck (28.9%) and lower extremities (29.7%), while adolescents and adults had melanoma of the trunk (40.5% and 34.2%), p<0.01. While a majority of patients were Caucasian, significantly more children were Hispanic (16.1% vs. 5.5% and 2.9%, p<0.01), African American (2.1% vs. 0.8% and 0.5%, p<0.01), and Asian/Pacific Islander (6.1% vs. 1.2% and 0.6%, p<0.01). Children had significantly lower rates of localized disease (72.8% vs. 84.6% and 85.9%, p<0.01), higher rates of regional disease (22.3% vs. 13.2% and 10.0%, p<0.01) and deeper tumors (28.0% vs. 9.7% and 9.4% had tumors>3.00mm, p<0.01). Surgery was the most common treatment modality and was associated with prolonged survival among all age groups. Despite presenting with more advanced disease, children and adolescents experienced lower overall (6.4% and 9.9% vs. 28.4%, p<0.01) and cancer-specific mortality (1.4% and 2.0% vs. 15.4%, p<0.01) compared to adults. Similarly, children and adolescents experienced significantly higher 5-year overall (91% and 84% vs. 53%, p<0.01) and cancer-specific survival (94% and 88% vs. 79%, p<0.01).
Conclusions: Melanoma among children occurs most commonly among females, often affects the head and neck regions, and has a significantly higher incidence rate among ethnic minorities. In contrast, adolescents present similarly to adults with primarily truncal melanoma and lower rates of metastatic and deep tumors. All pediatric age (<20 years) patients experience prolonged overall and cancer-specific survival compared to adults. Understanding disparities in pediatric melanoma presentation, incidence and survival should help to increase disease awareness and prevention as well as facilitating early detection.