Melanoma and Melanocytic Tumors of Uncertain Malignant Potential in Children, Adolescents and Young Adults-The Stanford Experience 1995-2008
Melanoma and Melanocytic Tumors of Uncertain Malignant Potential in Children, Adolescents and Young Adults-The Stanford Experience 1995-2008
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DOI：
10.1111/j.1525-1470.2009.01078.x
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发表时间：
2010-05-01
影响因子：
1.5
通讯作者：
Swetter, Susan M.
中科院分区：
文献类型：
--
作者：
Berk, David R.;LaBuz, Elizabeth;Swetter, Susan M.
儿童黑色素瘤是很难研究的，因为它的罕见性，可能的生物学差异，在青春期前与青少年相比，和挑战，真正的黑色素瘤从非典型spitzoid肿瘤。不确定性病变有时被称为恶性潜能不确定的黑色素细胞肿瘤（MelTUMP）。我们对1995年至2008年21岁及以下患者中的黑色素瘤、MelTUMP和Spitz痣伴非典型特征（SNAF）进行了回顾性、单机构审查。我们确定了13例黑色素瘤患者，7例MelTUMP患者和5例SNAF患者。黑色素瘤患者的中位年龄为17岁，MelTUMP为10岁，SNAF为6岁。在13名黑色素瘤患者中，只有4名年龄小于15岁，6名为青少年，3名为年轻人。9例黑色素瘤患者（69%）为女性。最常见的组织学亚型是浅表扩散型。黑色素瘤的中位深度为1.2 mm，MelTUMP为3.4 mm。在2/10例（20%）原发性黑色素瘤和2/6例（33%）MelTUMP中，在选择性或前哨淋巴结（SLN）清扫时检测到显微镜下区域淋巴结受累。四名黑色素瘤患者进行了完全淋巴结切除术，其中三例阳性。截至2009年3月31日的患者结局显示，MelTUMP或SNAF患者无转运或内脏转移。1例SLN阳性的黑色素瘤患者（8%）出现淋巴结复发和肝转移，并在初步诊断后15个月死亡。我们的数据强调了儿童黑色素瘤SLN阳性的罕见性、女性优势和显著性。MelTUMP合并区域淋巴结疾病的高发生率强化了密切随访的必要性。
Pediatric melanoma is difficult to study because of its rarity, possible biological differences in preadolescents compared with adolescents, and challenges of differentiating true melanoma from atypical spitzoid neoplasms. Indeterminant lesions are sometimes designated as melanocytic tumors of uncertain malignant potential (MelTUMPs). We performed a retrospective, single-institution review of melanomas, MelTUMPs and Spitz nevi with atypical features (SNAFs) in patients at 21 years of age and younger from 1995 to 2008. We identified 13 patients with melanoma, seven with MelTUMPs, and five with SNAFs. The median age for melanoma patients was 17 years, 10 for MelTUMPs, and six for SNAFs. Of the 13 melanoma patients, only four were younger than 15 years, while six were adolescents, and three were young adults. Nine melanoma patients (69%) were female. The most common histologic subtype was superficial spreading. The median depth for melanomas was 1.2 mm, and 3.4 mm for MelTUMPs. Microscopic regional nodal involvement detected on elective or sentinel lymph node (SLN) dissection was present in 2/10 (20%) of primary melanomas and 2/6 (33%) of MelTUMPs. Complete lymphadenectomy was performed on four melanoma patients, with three positive cases. Patient outcome through March 31, 2009 revealed no in-transit or visceral metastasis in patients with MelTUMPs or SNAFs. One SLN-positive patient (8%) with melanoma developed recurrent lymph node and liver metastasis and died 15 months after primary diagnosis. Our data highlight the rarity, female predominance, and significant rate of SLN positivity of pediatric melanoma. The high rate of MelTUMPs with regional nodal disease reinforces the need for close follow-up.