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Original Investigation |

Survival and Surgical Outcomes for Pediatric Head and Neck Melanoma ONLINE FIRST

Morgan K. Richards, MD, MPH1,2; Josephine Czechowicz, MD3; Adam B. Goldin, MD, MPH2; Kenneth W. Gow, MD2; John Doski, MD4; Melanie Goldfarb, MD5; Jed Nuchtern, MD6; Monica Langer, MD7; Elizabeth A. Beierle, MD8; Sanjeev Vasudevan, MD6; Deepti Gupta, MD9; Sanjay R. Parikh, MD3
[+] Author Affiliations
1Department of Surgery, University of Washington, Seattle
2Division of Pediatric General and Thoracic Surgery, Seattle Children’s Hospital, Seattle, Washington
3Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle
4Division of Pediatric Surgery, Methodist Children’s Hospital of South Texas, San Antonio
5Department of Surgery, John Wayne Cancer Institute, Santa Monica, California
6Division of Pediatric Surgery, Baylor College of Medicine, Houston, Texas
7Maine Children’s Cancer Program, Portland
8Pediatric General Surgery, University of Alabama at Birmingham
9Department of Dermatology, Seattle Children’s Hospital, Seattle, Washington
JAMA Otolaryngol Head Neck Surg. Published online September 08, 2016. doi:10.1001/jamaoto.2016.2630
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Importance  Melanoma in children is rare, accounting for approximately 2% of all pediatric malignant neoplasms. However, for the past 30 years, the incidence of melanoma in those younger than 20 years has been increasing. Location of the primary tumor has been shown to be an important prognostic factor, with melanomas of the scalp and neck conferring a worse prognosis than those originating at other sites.

Objective  To examine the survival, demographic, tumor, and treatment characteristics of pediatric head and neck melanoma.

Design, Setting, and Participants  We performed a retrospective cohort study using information from the National Cancer Data Base from January 1, 1998, to December 31, 2012, on pediatric (≤18 years) and adult (>18 years) patients with head and neck melanoma. Data analysis was conducted from August 1, 2015, to June 30, 3016.

Exposure  Pediatric age (≤18 years) at diagnosis of head and neck melanoma.

Main Outcomes and Measures  Survival differences were estimated using a Cox proportional hazards regression model. Surgical outcomes, including nodal sampling and margin status, were estimated with generalized linear models comparing pediatric and adult patients. Patient demographic, tumor, and treatment characteristics were estimated using t tests and χ2 tests between pediatric and adult patients with head and neck melanoma for continuous and categorical data, respectively.

Results  Of the 84 744 patients with head and neck melanoma, 657 (0.8%) were 18 years or younger (mean [SD] age, 13.5 [4.7] years; 285 female and 372 male; 610 white). Pediatric and adult patients had similar demographics but different histologic subtypes (risk difference of pediatric vs adult patients: melanoma, not otherwise specified, 8.5% [95% CI, 4.7%-12.3%]; superficial spreading, 4.2% [95% CI, 0.89%-7.4%]; and lentigo maligna, –13.4% [95% CI, –14.1% to 12.6%]). Pediatric patients had tumors of similar mean depth to those in adult patients (pediatric, 1.54 mm; adult; 1.39 mm; absolute difference, 0.15 mm; [95% CI, –0.32 to 0.008]) and more frequent nodal metastases than did adult patients (risk difference of pediatric vs adult patients for stage T2, 23.9% [95% CI, 14.1%-33.6%]). Five-year survival among pediatric patients was higher for those with stage 1, 2, or 3 disease (absolute difference of pediatric vs adult patients: stage 1, 18% [95% CI, 9.7%-26.3%]; stage 2, 36% [95% CI, 25.3%-46.7%]; stage 3, 39% [95% CI, 26.8%-51.2%]; and stage 4, 2% [95% CI, –8.2% to 12.2%]).

Conclusions and Relevance  Although pediatric patients with head and neck melanoma present with similar tumor depth and more frequent nodal metastases than do adult patients, younger patients have higher overall survival.

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Figure.
Survival for Pediatric and Adult Patients With Head and Neck Melanoma Stratified by Stage of Disease

A, Survival of pediatric and adult patients with stage 1 head and neck melanoma (P < .001). B, Survival of pediatric and adult patients with stage 2 head and neck melanoma (P < .001). C, Survival of pediatric and adult patients with stage 3 head and neck melanoma (P < .001). D, Survival of pediatric and adult patients with stage 4 head and neck melanoma (P = .70).

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