Evaluation and Surgical Management of Pediatric Cutaneous Melanoma and Atypical Spitz and Non-Spitz Melanocytic Tumors (Melanocytomas): A Report From Children's Oncology Group
Abstract
PURPOSE The purpose of this study was to develop recommendations for the diagnostic evaluation and surgical management of cutaneous melanoma (CM) and atypical Spitz tumors (AST) and non-Spitz melanocytic tumors (melanocytomas) in pediatric (age 0-10 years) and adolescent (age 11-18 years) patients. METHODS A Children's Oncology Group–led panel with external, multidisciplinary CM specialists convened to develop recommendations on the basis of available data and expertise. RESULTS Thirty-three experts from multiple specialties (cutaneous/medical/surgical oncology, dermatology, and dermatopathology) established recommendations with supporting data from 87 peer-reviewed publications. RECOMMENDATIONS (1) Excisional biopsies with 1-3 mm margins should be performed when feasible for clinically suspicious melanocytic neoplasms. (2) Definitive surgical treatment for CM, including wide local excision and sentinel lymph node biopsy (SLNB), should follow National Comprehensive Cancer Network Guidelines in the absence of data from pediatric-specific surgery trials and/or cohort studies. (3) Accurate classification of ASTs as benign or malignant is more likely with immunohistochemistry and next-generation sequencing. (4) It may not be possible to classify some ASTs as likely/definitively benign or malignant after clinicopathologic and/or molecular correlation, and these Spitz tumors of uncertain malignant potential should be excised with 5 mm margins. (5) ASTs favored to be benign should be excised with 1- to 3-mm margins if transected on biopsy. (6) Re-excision is not necessary if the AST does not extend to the biopsy margin(s) when complete/excisional biopsy was performed. (7) SLNB should not be performed for Spitz tumors unless a diagnosis of CM is favored on clinicopathologic evaluation. (8) Non-Spitz melanocytomas have a presumed increased risk for progression to CM and should be excised with 1- to 3-mm margins if transected on biopsy. (9) Re-excision of non-Spitz melanocytomas is not necessary if the lesion is completely excised on biopsy.
Article Details
Journal Info
Journal of Clinical Oncology
Lippincott Williams & Wilkins
Authors (33)
Michael R. Sargen
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
Raymond L. Barnhill
Department of Translational Research, Institut Curie, Unit of Formation and Research of Medicine University of Paris Cité, Paris, France
David E. Elder
Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
Susan M. Swetter
Stanford University School of Medicine, Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford, CA
Victor G. Prieto
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
Jennifer S. Ko
Armita Bahrami
Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
Pedram Gerami
Arivarasan Karunamurthy
Alberto S. Pappo
St. Jude Children's Research Hospital, Memphis, TN
Lynn M. Schuchter
University of Pennsylvania, Philadelphia, PA
Philip E. LeBoit
Departments of Dermatology and Pathology, Helen Diller Family Cancer Center, University of California, San Francisco, San Francisco, CA
Iwei Yeh
John M. Kirkwood
Melinda Jen
Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Ira J. Dunkel
Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
Megan M. Durham
Department of Surgery, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA
Emily R. Christison-Lagay
Division of Pediatric Surgery, Yale School of Medicine, Yale New-Haven Children's Hospital, New Haven, CT
Mary T. Austin
Division of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Jennifer H. Aldrink
Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
Casey Mehrhoff
Division of Pediatric Hematology/Oncology, University of Utah School of Medicine; Huntsman Cancer Institute at the University of Utah; Primary Children's Hospital, Salt Lake City, UT
Elena B. Hawryluk
Department of Dermatology, Massachusetts General Hospital, Boston
Emily Y. Chu
Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Klaus J. Busam
Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
Vernon Sondak
H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
Jane Messina
H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
Susana Puig
Andrew J. Colebatch
Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
Carrie C. Coughlin
Division of Dermatology, Departments of Medicine and Pediatrics, Washington University School of Medicine in St Louis, St Louis, MO
Kristen G. Berrebi
Departments of Dermatology and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA
Theodore W. Laetsch
Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
Sarah G. Mitchell
Department of Pediatrics, Emory University School of Medicine, Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
Brittani Seynnaeve
Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA