From Johns Hopkins Medicine, Baltimore, Maryland
Author's disclosure of potential conflicts of interest is found at the end of this article.
Address reprint requests to Julie R. Lange, MD, ScM, Johns Hopkins Medicine, 600 N. Wolfe Street, Carnegie 681, Baltimore, MD 21287; e-mail jlange{at}jhmi.edu
Overview: Melanoma is uncommon in teenagers and rare in people who are younger than age 15. In the United States in 2003, the Centers for Disease Control and Prevention estimated 466 new cases of invasive melanoma for people who were age 19 and younger and only 118 new cases for children who were younger than 15. The Surveillance, Epidemiology, and End Results database in the United States reported a rise in the incidence of melanoma from 1973 to 2001 of 1.4% per year in children who were younger than age 10 and 3.0% per year in those who were age 10 to 19. Melanoma is very rare in prepubertal children; a sharp increase in melanoma incidence occurs at approximately age 12 and is greater in girls than in boys. Some melanocytic lesions in childhood are hard to classify pathologically as benign or malignant. Even for experienced dermatopathologists, one frequent difficulty is differentiating Spitz nevus from Spitzoid melanoma. Younger children have significantly more head and neck melanomas and significantly fewer truncal melanomas compared with teenagers and young adults. Younger children present with more advanced stage of disease than older children and young adults. Treatment of stage 0 to III melanoma in children is primarily surgical. For pediatric patients with high-risk, resected melanoma (usually node-positive disease), the use and tolerability of high-dose interferon alpha has been demonstrated in a few small series. Overall survival of children with melanoma is clearly related to stage at presentation, as it is for adults; boys seem to have poorer survival than girls.
