Abstract
Background
Malignant melanoma is rare in the pediatric population and management is largely extrapolated
from adult guidelines. Adult data have shown that immediate completion lymph node
dissection (CLND) does not improve overall survival in selected patients with clinically
node negative, sentinel lymph node-positive disease. Current nodal management in children
is unknown.
Methods
The National Cancer Database (NCDB) was queried for patients with melanoma from 2012-2017
and patients categorized as pediatric (≤18 years, n=962) or adult (n=327,987). Factors
associated with CLND in children with positive SLNB were evaluated in multivariable
analysis. Kaplan-Meier survival analysis was performed.
Results
Compared to adults, children present with thicker primary tumors (T3 or T4 26.5% vs
15.5%, p<0.001), resulting in higher rates of nodal assessment with SLN biopsy or
LND (60.2% vs 36.6%, p<0.001) and higher rates of regional nodal disease (35.1% vs
23.4%, p<0.001). Children underwent higher rates of CLND after SLN biopsy (10.4% vs
4.1%) and upfront lymph node dissection (15.2% vs 8.7%). A decreased rate of CLND
was noted in 2017 compared to 2012 (odds ratio (OR) 0.16 (p=0.005). CLND was performed
more often on multivariable analysis for older pediatric age (>12 years, OR=1.6, p=0.037)
and lower extremity primary (OR=0.29, p<0.001). Children with regional nodal disease
have improved 3-year overall survival compared to adults (96.5% vs 71.0%, p<0.001).
Conclusions
Children with melanoma have higher rates of nodal disease but better survival than
adults. As in adults, there has been a recent increase in close nodal observation
rather than CLND for patients with positive SLN. Further study of nodal surveillance
for pediatric patients is warranted.
Keywords
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Article info
Publication history
Published online: November 09, 2021
Accepted:
October 30,
2021
Received in revised form:
October 25,
2021
Received:
September 22,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
