Higher rates of regional disease but improved outcomes in pediatric versus adult melanoma

Published:November 09, 2021DOI:



      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.


      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.


      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).


      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.


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      1. American Cancer Society. Facts & Figures 2021. American cancer societ y. Atlanta, Ga. 2021

      2. National cancer institute: SEER stat fact sheets: melanoma of the skin. Bethesda, Md: national cancer institute. Available online. 2021.

        • Livestro D.P.
        • Kaine E.M.
        • Michaelson J.S.
        • et al.
        Melanoma in the young: differences and similarities with adult melanoma: a case-matched controlled analysis.
        Cancer. 2007; 110: 614-624
        • Howman-Giles R.
        • Uren R.F.
        • Thompson J.
        Sentinel lymph node biopsy in pediatric and adolescent patients: a proven technique.
        Ann Surg. 2014; 259: e86
      3. NCCN guidelines version 2.2021; Melanoma cutaneous

        • Wong S.L.
        • Faries M.B.
        • Kennedy E.B.
        • et al.
        Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: American society of clinical oncology and society of surgical oncology clinical practice guideline update.
        J Clin Oncol Off J Am Soc Clin Oncol. 2018; 36: 399-413
        • Faries M.B.
        • Thompson J.F.
        • Cochran A.J.
        • et al.
        Completion dissection or observation for sentinel-node metastasis in melanoma.
        N Engl J Med. 2017; 376: 2211-2222
        • Leiter U.
        • Stadler R.
        • Mauch C.
        • et al.
        Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial.
        Lancet Oncol. 2016; 17: 757-767
        • Bilimoria K.Y.
        • Stewart A.K.
        • Winchester D.P.
        • et al.
        The national cancer data base: a powerful initiative to improve cancer care in the United States.
        Ann Surg Oncol. 2008; 15: 683-690
        • Siegel D.A.
        • King J.
        • Tai E.
        • et al.
        Cancer incidence rates and trends among children and adolescents in the United States, 2001–2009.
        Pediatrics. 2014; 134: e945-e955
        • Campbell L.B.
        • Kreicher K.L.
        • Gittleman H.R.
        • et al.
        Melanoma incidence in children and adolescents: decreasing trends in the United States.
        J Pediatr. 2015; 166 (Jun;): 1505-1513
        • Wong J.R.
        • Harris J.K.
        • Rodriguez-Galindo C.
        • et al.
        Incidence of childhood and adolescent melanoma in the United States: 1973–2009.
        Pediatrics. 2013; 131: 846-854
        • Austin M.T.
        • Xing Y.
        • Hayes-Jordan A.A.
        • et al.
        Melanoma incidence rises for children and adolescents: an epidemiologic review of pediatric melanoma in the United States.
        J Pediatr Surg. 2013; 48: 2207-2213
        • Saenz N.C.
        • Saenz-Badillos J.
        • Busam K.
        • et al.
        Childhood melanoma survival.
        Cancer. 1999; 85: 750-754
        • Lam P.H.
        • Obirieze A.C.
        • Ortega G.
        • et al.
        An age-based analysis of pediatric melanoma: staging, surgery, and mortality in the surveillance, epidemiology, and end results database.
        Am Surg. 2018; 84 (May 1): 739-745
        • Lu C.
        • Zhang J.
        • Nagahawatte P.
        • et al.
        The genomic landscape of childhood and adolescent melanoma.
        Invest Dermatol. 2015; 135 (Mar): 816-823
        • Lange J.R.
        • Palis B.E.
        • Chang D.C.
        • et al.
        Melanoma in children and teenagers: an analysis of patients from the National cancer data base.
        J Clin Oncol. 2007; 25: 1363-1368
        • Livestro D.P.
        • Kaine E.M.
        • Michaelson J.S.
        • et al.
        Melanoma in the young: differences and similarities with adult melanoma: a case-matched controlled analysis.
        Cancer. 2007; 110: 614-624
        • Lorimer P.D.
        • White R.L.
        • Walsh K.
        • et al.
        Pediatric and adolescent melanoma: a national cancer data base update.
        Ann Surg Onc. 2016; 23: 4058-4066
        • van Akkooi A.C.
        • Bouwhuis M.G.
        • de Wilt J.H.
        • et al.
        Multivariable analysis comparing outcome after sentinel node biopsy or therapeutic lymph node dissection in patientswith melanoma.
        Br J Surg. 2007; 94: 1293-1299
        • Wong S.L.
        • Morton D.L.
        • Thompson J.F.
        • et al.
        Melanoma patients with positive sentinel nodes who did not undergo completion lymphadenectomy: a multi-institutional study.
        Ann Surg Oncol. 2006; 13: 809-816
        • Herb J.N.
        • Dunham L.N.
        • Ollila D.W.
        Use of completion lymph node dissection for sentinel lymph node positive melanoma.
        J Am Coll Surg. 2020; 230: 515-524
        • Hewitt D.B.
        • Merkow R.P.
        • DeLancey J.O.
        • et al.
        National practice patterns of completion lymph node dissection for sentinel node-positive melanoma.
        J Surg Oncol. 2018; 118: 493-500
        • Moore-Olufemi S.
        • Herzog H.
        • Warneke C.L.
        • et al.
        Outcomes in pediatric melanoma: comparing prepubertal to adolescent pediatric patients.
        Ann Surg. 2011; 253: 1211-1215
        • Freemyer B.
        • Hamilton E.
        • Warneke C.L.
        • et al.
        Treatment outcomes in pediatric melanoma - are there benefits to specialized care?.
        J Ped Surg. 2016; 51: 2063-2067