Skin Cancer In Children Research Articles

The Impact of Surgical Margin in Wide Local Excision of Pediatric Melanoma – An Argument for a More Conservative Approach

BackgroundPediatric melanoma is the most common skin cancer in children. Achieving surgical margins recommended by the National Comprehensive Cancer Network (NCCN) for wide local excision (WLE) is challenging in children with less body domain. This study investigated whether surgical margin impacted postoperative clinical outcomes following WLE for melanoma in children and adolescents. MethodsAll patients ≤21 years undergoing WLE between 2007 and 2023 were analyzed. Patients were categorized in groups of surgical margin <2 cm vs. ≥2 cm. The chi-square test/Fisher's exact test and Mann–Whitney U test were used to analyze categorical and continuous variables between groups. Multivariate logistic regression was used to determine the association of age and tumor location with surgical margin group and whether NCCN guidelines for WLE were met. ResultsOf the 59 patients included, 61% had WLE with <2 cm margins. Head/neck melanomas were less likely to have margins ≥2 cm (OR = 0.121, 95% CI 0.022–0.648, p = 0.014) and margins that met the NCCN guidelines (OR = 0.002, 95% CI 0.003–0.215, p < 0.001) when compared to trunk/extremity primaries. There was no difference in the rate of postoperative complications or need for intervention for complications between patients with margins <2 cm and those with ≥2 cm. No patients experienced local recurrence with a median follow-up of 52 months (IQR: 16 to 93). ConclusionPediatric head/neck melanomas undergoing WLE were likelier to have narrow margins <2 cm and less likely to meet NCCN criteria. Narrow margins may achieve excellent results for pediatric melanoma patients. Type of StudyThis is a treatment study. Levels of EvidenceThis is a Level III retrospective comparative study.

Adjuvant immune checkpoint inhibitor therapy may benefit pediatric patients with stage III melanoma and sentinel lymph node positivity: a case series

Melanoma is the most common skin cancer in children. While the current literature establishes treatment protocols for adult-type melanoma, very few pediatric-specific studies exist, and children are often excluded from melanoma clinical trials2. We report a case series of 23 pediatric patients aged 2–20 years old diagnosed with melanoma at the University of Rochester Medical Center between 1/1/2011 and 1/1/2022. 9/23 patients were Stage III; all patients underwent wide local excision and 9 received adjuvant therapies. 2/23 (8.7%) patients had recurrence of their malignancy after therapy while 21/23 (91.3%) remained without disease progression; 1 patient died from unknown cause, but the rest are alive and currently without disease. All patients whose initial therapy included nivolumab in addition to wide local excision did not have recurrence or progression of their disease. This case series highlights trends in the presentation, treatment, and outcomes of pediatric melanoma; however, additional multi-center studies are needed to establish the clinical utility of such features in pediatric melanoma.

Pediatric Melanoma: Geographic Trends in Incidence, Stage, and Mortality in the United States

IntroductionPediatric melanoma is the most commonly diagnosed skin cancer in children, with the annual incidence recently increasing by an average of 2% each year. Ultraviolet (UV) radiation from excessive sun exposure is an important carcinogenic risk factor, with penetration varying greatly throughout the country. Consequently, an individual's geographic location may play a role in how much exposure to high UV index rays they receive throughout their lifetime. The objective of this study was to use the surveillance, epidemiology, and end results SEER database to study geographic trends in incidence, staging, and mortality of pediatric melanoma between 2009 and 2019 and determine their relation to UV index in the United States. Materials and methodsA retrospective analysis of pediatric patients from 0 to 19 years in the surveillance, epidemiology, and end results 22 registries incidence database (17 states) and 17 registries incidence-based mortality database (12 states) was conducted from 2009 to 2019 based on a diagnosis of melanoma of the skin using the International Classification of Childhood Cancer codes for malignant melanoma. Data regarding patient demographics and incidence, staging, and mortality per state were extracted. Incidence data were geographically mapped and mean UV index distribution from www.epa.gov was superimposed. ResultsIncidence of pediatric melanoma was stratified regionally, with a total of 1665 new cases from 2009 to 2019. The Northeast had 393 new cases, with 244 (62.1%) localized cases, 55 (14.0%) lymph node-invasive and metastatic (advanced) cases, and 6/146 (4.1%) cases of mortality. The Midwest had 209 new cases, with 123 (58.9%) localized cases, 29 (13.9%) advanced cases, and 1/57 (1.8%) case of mortality. The South had 487 new cases, with 224 (46.0%) localized cases, 104 (21.4%) advanced cases, and 8/232 (3.4%) cases of mortality. The West had 576 new cases, with 364 (63.2%) localized cases, 82 (14.2%) advanced cases, and 23/551 (4.2%) cases of mortality. Mean UV index was 4.4 in the Northeast, 4.8 in the Midwest, 7.3 in the South, and 5.5 in the West from 2006 to 2020. The regional difference in incidence was not statistically significant. There was a statistically significant increased number of advanced cases in the South as compared to the Northeast (P = 0.005), West (P = 0.002), and Midwest (P = 0.02), with a significant correlation coefficient of 0.7204 between advanced cases and mean UV index in the South. ConclusionsThere is a statistically significant increased incidence of lymph node-invasive and metastatic pediatric melanoma cases in the South as compared to the West, Northeast, and Midwest regions of the United States. There is also a significant correlation between the incidence of lymph node-invasive and metastatic pediatric melanoma cases and UV index. In the pediatric population, there is no statistically significant association between total incidence and mortality of melanoma and geographic region. There is an increased prevalence of pediatric melanoma seen in White and female patients. This suggests that an individual's geographic location in the United States during childhood may play a role in their likelihood of malignant melanoma development, advanced-stage melanoma development, and mortality.

Source of polycyclic aromatic hydrocarbons (PAHs) in rainwater and effect on the health of the population: the case of the District of Abidjan in the South of Ivory Coast.

Rainwater pollution in urban areas is a real phenomenon globally, particularly in developing countries. This study aims to trace the origin of polycyclic aromatic hydrocarbons (PAHs) in the Abidjan district's rainwater and to evaluate the health risk to the population. Ten water samples were collected at two sites during the dry and rainy seasons over a 2-year period. The use of molecular indices and profiles as well as Spearman's correlation matrix revealed that the pyrolytic sources, such as wood combustion as well as road traffic, remain the main sources of these pollutants in the water. The risk assessment revealed a higher risk of skin cancer in children.

Environmental Interventions Targeting Skin Cancer in Children

Environmental Interventions Targeting Skin Cancer in Children

044 Nonmelanoma skin cancer in children and young adults with iatrogenic risk factors

044 Nonmelanoma skin cancer in children and young adults with iatrogenic risk factors

Characteristics of nonmelanoma skin cancer in children without identifiable risk factors

Characteristics of nonmelanoma skin cancer in children without identifiable risk factors

Pediatric Melanoma: Epidemiology, Pathogenesis, Diagnosis and Management

Pediatric melanoma is the most common skin cancer in children. However, it is extremely rare this population, being even rarer in younger than 10 years of age. Its diagnosis is often difficult, due to its rarity and atypical presentations. There are three main subtypes of pediatric melanoma: Spitzoid melanoma, melanoma arising in a congenital melanocytic nevus and conventional melanoma. Congenital melanomas exist and are exceptionally rare, although they do not constitute a different subtype of melanoma. Spitzoid melanoma is the most common subtype affecting children younger than 11 years. Despite presenting with local aggressive features and frequent nodal involvement, it encompasses an excellent prognosis. The risk of malignant transformation of congenital melanocytic nevi varies widely accordingly to the projected adult size, number, and concomitant abnormalities found in the central nervous system. The surveillance and treatment of melanoma arising in a congenital melanocytic nevus is challenging, enclosing poor outcomes. In adolescents, the most common subtype is the conventional (adult-type). Contrary to the adult population, the majority of conventional pediatric melanoma arises from previous nevi but follows the general adult epidemiology and risk factors. Specific guidelines for management of pediatric melanoma do not exist and it is treated similarly to melanoma in the adult.

Characteristics of nonmelanoma skin cancer in children without identifiable risk factors

Characteristics of nonmelanoma skin cancer in children without identifiable risk factors

Risk Factors and Outcomes of Nonmelanoma Skin Cancer in Children and Young Adults

To identify risk factors associated with nonmelanoma skin cancer (NMSC) occurrence and survival in children. This was a multicenter, retrospective, case-control study of patients <20years of age diagnosed with NMSC between 1995 and 2015 from 11 academic medical centers. The primary outcome measure was frequency of cases and controls with predisposing genetic conditions and/or iatrogenic exposures, including chemotherapy, radiation, systemic immunosuppression, and voriconazole. Of the 124 children with NMSC (40 with basal cell carcinoma, 90 with squamous cell carcinoma), 70% had at least 1 identifiable risk factor. Forty-four percent of the cases had a predisposing genetic condition or skin lesion, and 29% had 1 or more iatrogenic exposures of prolonged immunosuppression, radiation therapy, chemotherapy, and/or voriconazole use. Prolonged immunosuppression and voriconazole use were associated with squamous cell carcinoma occurrence (cases vs controls; 30% vs 0%, P=.0002, and 15% vs 0%, P=.03, respectively), and radiation therapy and chemotherapy were associated with basal cell carcinoma occurrence (both 20% vs 1%, P<.0001). Forty-eight percent of initial skin cancers had been present for >12months prior to diagnosis and 49% of patients were diagnosed with ≥2 skin cancers. At last follow-up, 5% (6 of 124) of patients with NMSC died. Voriconazole exposure was noted in 7 cases and associated with worse 3-year overall survival (P=.001). NMSC in children and young adults is often associated with a predisposing condition or iatrogenicexposure. High-risk patients should be identified early to provide appropriate counseling and management.

Skin cancer in children after organ transplantation.

Skin cancer is the second most common complication of organ transplantation in children. The frequency of skin cancer incidence after organ transplantation is different in paediatric and adult populations. The post-transplant lymphoproliferative disease is the most common group of malignancies after organ transplantation in paediatric population. The majority of researchers who examined children with kidney, liver, heart or lungs grafts observed that the risk of skin cancer was three times higher than in the general population whereas in adults even200 times higher. The occurrence of skin cancer in children after transplantation is extremely rare during childhood. The risk increases in early adulthood. Malignancies occurring after solid organ transplantation result from many different factors. These include the immunological condition of the child, dose and time of immunosuppression, and oncogenic viruses. The increased risk of skin cancer following paediatric transplantation requires prevention and adequate education of children and their parents. These involve avoiding sun exposure and protection such as sunscreens and protective clothing. The early detection of cancer in transplant recipients is very important. Prevention of cancer includes regular dermatological examination.

Children with malignant melanoma: a single center experience from Turkey.

Aim:Malignant melanoma is the most frequent skin cancer in children and adolescents. It comprises 1–3% of all malignancies. In this study, we aimed to evaluate the clinical aspects, histopathologic features, and treatment outcomes of our patients with malignant melanoma.Material and Methods:Patients aged <15 years who were treated between 2003 and 2018 for malignant melanoma were retrospectively analyzed.Results:Seventeen patients (10 females, 7 males), with a median age of 7 years (range, 7 months-13 years) were evaluated. Five patients had congenital melanocytic nevi. All had cutaneous melanoma except one with mucosal (conjunctival) melanoma. The most frequent primary tumor site was the lower extremities (35%). Sentinel lymphoscintigraphy, sentinel node biopsy, and PET/CT were performed as the staging procedures at initial diagnosis. Localized disease was present in eight patients; nine had regional lymph node metastasis. The only treatment was surgery in localized disease; surgery and adjuvant interferon treatment was given in patients with regional lymph node metastasis. Three developed distant metastasis (bone, lung, brain) at a median of 9 months. A three-year-old patient received a BRAF inhibitor (vemurafenib), and a 13-year-old patient received a check point inhibitor (ipilimumab); both died of progressive disease. The median follow-up for all patients was 25 months. The 5-year overall survival was 76.6%.Conclusion:Although malignant melanoma is rare in children, prognosis is good if diagnosed early. Physicians should be aware of skin lesions and full-layer biopsy should be obtained in suspicious skin lesions. Patients with congenital melanocytic nevi should also be followed up cautiously.

Voriconazole and skin cancer in children

Voriconazole and skin cancer in children

Paediatric melanoma.

Paediatric melanoma, although rare, is the most common skin cancer in children. Our current knowledge on paediatric melanoma incidence trends is expanding, as several studies have addressed this issue with conflicting results. Known risk factors for paediatric melanoma include family history of melanoma, a previous history of malignancy, large congenital nevi, numerous melanocytic nevi, sunburns, increased UV exposure and a sun-sensitive phenotype. In younger children, melanoma more often presents with atypical features, such as a changing, amelanotic or uniformly coloured, often bleeding lesion, not fulfilling in most cases the conventional ABCDE criteria. The major differential diagnoses are melanocytic nevi, proliferative nodules in congenital nevi and atypical Spitz tumours. Moreover, in the younger age group non-Caucasian children are over-represented, tumours tend to be thicker and lymph nodes are often involved. Despite the frequent diagnosis at an advanced stage, the overall survival is fair in paediatric melanoma. Specific guidelines for management of melanoma in children do not exist, and most often the disease is treated similarly to melanoma in adults.

Pediatric melanoma: incidence, treatment, and prognosis.

The purpose of this review is to outline recent advancements in diagnosis, treatment, and prevention of pediatric melanoma. Despite the recent decline in incidence, it continues to be the deadliest form of skin cancer in children and adolescents. Pediatric melanoma presents differently from adult melanoma; thus, the traditional asymmetry, border irregularity, color variegation, diameter >6 mm, and evolution (ABCDE) criteria have been modified to include features unique to pediatric melanoma (amelanotic, bleeding/bump, color uniformity, de novo/any diameter, evolution of mole). Surgical and medical management of pediatric melanoma continues to derive guidelines from adult melanoma treatment. However, more drug trials are being conducted to determine the specific impact of drug combinations on pediatric patients. Alongside medical and surgical treatment, prevention is a central component of battling the incidence, as ultraviolet (UV)-related mutations play a central role in the vast majority of pediatric melanoma cases. Aggressive prevention measures targeting sun safety and tanning bed usage have shown positive sun-safety behavior trends, as well as the potential to decrease melanomas that manifest later in life. As research into the field of pediatric melanoma continues to expand, a prevention paradigm needs to continue on a community-wide level.

Open-label, multicenter, single-arm, phase I, dose-dscalation with efficacy tail extension study of vemurafenib in pediatric patients with surgically incurable and unresectable stage IIIc or IV melanoma harboring BRAFV600 mutations (NCT01519323).

TPS9104 Background: Although rare, melanoma is the most common form of skin cancer in children and the incidence is rising in the adolescent population. Similar to adults, the outcome for pediatric patients with advanced or recurrent melanoma is poor. Many adult studies of melanoma exclude patients under the age of 18 years. Approximately 50% of melanomas carry a mutation in the BRAF gene and the oral BRAF inhibitor vemurafenib (VEM) has demonstrated improved rates of overall and progression-free survival in adult melanoma patients who carry this mutation (Chapman et al; NEJM 2011). The current study is designed to determine the maximum tolerated dose (MTD)/recommended dose (RD), pharmacokinetics, safety, tolerability, and efficacy of VEM in pediatric patients with surgically incurable and unresectable stage IIIC/IV melanoma harboring BRAFV600mutations. Methods: Patients aged 12 through 17 years with newly diagnosed or previously treated measurable disease are eligible. Patients with radiographically stable, asymptomatic previously treated central nervous system lesions are also eligible. In the dose-escalation phase, patients will be enrolled sequentially to increasing dose cohorts of VEM following a 3+3 design. Dose-limiting toxicity will be assessed during the first cycle (defined as the first 28 days). The initial dose will be 720 mg BID (patients ≥45 kg) or 480 mg BID (patients &lt;45 kg). Once the MTD/RD for the extension phase is defined based on the dose-escalation window, all patients will be eligible to receive the MTD/RD. The efficacy tail of the trial will enroll additional pediatric patients at the MTD/RD. Patients will receive VEM until disease progression, death, unacceptable tolerability, discontinuation from the study, or other protocol-specified criteria. The study aims to treat approximately 20 patients at the RD with 3-15 additional patients treated at other dose levels during the dose-escalation phase. This study is currently open at 18 sites in the USA, UK, Germany, Italy, and Australia. As of January 24, 2013, one patient has been enrolled. Clinical trial information: NCT01519323.

Chronic Graft-versus-host Disease and Non-melanoma Skin Cancer in Children: Report of Two Cases

This article does not have an abstract

Primary Prevention of Skin Cancer in Children and Adolescents: A Review of the Literature

Although skin cancer is an easily preventable disease, self-directed prevention behaviors in children are difficult to achieve. The purpose of this article is to evaluate the status of primary prevention interventions and identify gaps in national and international research in order to make suggestions for further intervention design. A comprehensive search of MEDLINE, CINAHL, and PSYCHinfo databases was conducted to collect published research used in this review. The most effective interventions used multicomponent curricula administered over an extended period of time. Younger children were more receptive to interventions than were older children, who had stronger attitudes against sun-protective behaviors. Interventions in Australia have been more successful than interventions in North America and Europe. Further research needs to be conducted to create primary prevention interventions that address informational gaps. Specifically testing the dose and effect of individual educational components and bundling of components with reliable and valid outcome measures would help health care researchers define and measure the most effective way to battle social norms and attitudes of children and sun exposure.

Policy and Practice for Preventing Skin Cancer in Children

This paper identifies what is known and what is not known about the link between sun exposure and skin cancer and what can be done to reduce sun exposure in children. There is evidence for the use of sun protective clothing and of the effectiveness of sunscreens for some, but not all, forms of skin cancer. While there is some evidence to support interventions in schools, there is insufficient evidence to support other interventions aimed at children or their caregivers. There is no clear means of assessing the "trade-off" between the benefits and harms of sunlight exposure, and the impact of sun protection strategies on other health promotion messages aimed at children is unknown. Reliance on educational interventions in schools may benefit from a broader approach that includes more emphasis on protective clothing and structural changes in the school day. Sun protection messages should be linked with other health promotion messages targeting children.

Skin cancer in children and young adults

Little population-based data has been published about skin cancers in children and young adults. In this study, 200 cases of melanoma and non-melanoma skin cancers diagnosed under 25 years of age in the North of England from 1968–1995 were obtained from the Northern Region Young Persons’ Malignant Disease Registry. The incidence was 1.2 cases per million per year for children (aged 0–14 years) and was 13 cases per million per year for young adults (aged 15–24 years). Melanoma accounted for 138 cases, of which 16 were in subjects aged < 15 years at diagnosis. The incidence of melanoma increased in females at a rate of 5.6 per million per decade (95% confidence interval [CI] 2.2–8.9, P = 0.002), largely due to an increased incidence of primary lower limb tumours. The incidence for males was unchanged. Survival improved significantly over time for both males and females (P ≤ 0.02). Of the 62 patients with non-melanoma skin cancers, 66% were diagnosed with primary non-basal cell carcinoma, 13% with dermatofibrosarcoma protuberans, 10% with squamous cell carcinoma and 11% with other tumours. Two cases were iatrogenic second malignancies following treatment for an earlier primary brain tumour. The incidence of non-melanoma skin cancers was significantly higher during 1982–1995 than during 1968–1981 (rate ratio 1.7, 95% CI 1.0–2.8). There were three deaths from non-melanoma skin cancer, and the overall 5 year survival rate was 98% (95% CI 89–100%). The reason for the increasing incidence of both melanoma and non-melanoma skin cancer in young people is unknown, but it is likely that ultraviolet exposure plays an aetiological role. It is important that families continue to be advised of the need for vigilance with regard to childhood sun exposure.