Three groups of tumors were studied. The first group was melanomas inadvertently transmitted from donors. Brain metastases from melanoma were often misdiagnosed in the donors as primary brain tumors or cerebral hemorrhage. Eleven donors provided organs to 20 recipients of whom 3 never manifested evidence of melanoma, 1 showed local spread of tumor beyond the allograft, and 16 had metastases. Of the last group 11 died from melanoma, but 4 patients had complete remissions following transplant nephrectomy and discontinuation of immunosuppressive therapy. The second group was melanomas treated pretransplantation. Thirty patients had cutaneous melanomas and one an ocular melanoma. Six patients (19%) had recurrences posttransplantation. Three were treated 0.76 mm by Breslow's technique). Lymph node metastases occurred in 32 patients (20%) with cutaneous melanomas. Fifty patients (30%) with cutaneous melanomas died of their malignancies, as did 5 with melanomas of unknown origin, and 1 with ocular melanoma. The risks of melanoma may be reduced by stringent selection of donors ; by waiting at least 5 years between treatment of melanoma and undertaking transplantation ; and, perhaps, by reducing sunlight exposure and by early excision of suspicious dysplastic lesions.

Malignant melanoma in organ allograft recipients.

Small congenital nevocellular nevi and the risk of cutaneous melanoma

Objective. We retrospectively analyzed the data from 33 patients who were up to 14 years of age and treated for cutaneous melanoma at the Istituto Na- zionale Tumori, Milan, over a 25-year period. Methods. Primary lesions were amelanotic in half of the cases and raised in 73%. Lower extremities were the most common primary sites. Histologically, 9 cases were classified as nodular type, and median thickness was 2.5 mm. Nine children had nodal involvement at diagnosis, 2 in-transit metastases, and 1 distant spread. Surgery was the mainstay of treatment; 9 patients underwent lymph node dissection, 3 received chemotherapy, and 2 received radiotherapy. Results. With a median follow-up of 122 months, 5-year event-free survival and overall survival were 60% and 70%, respectively. Age seemed to correlate with sur- vival, event-free survival being 90% in children under 10 and 47% in older patients, although the initial microstag- ing seemed worse in the former. Conclusion. By comparison with adult cases, child- hood melanoma can have a higher percentage of atypical clinical features (amelanotic and raised lesions), nodular histotype, and thick lesions. Although we have no data to support any suggestion of biological differences between young children and adolescents or adults, our findings give the impression that melanoma behaves better in the younger age group. Pediatrics 2005;115:000; age, children, cutaneous melanoma, pediatric rare tumors, prognostic factors.

Does melanoma behave differently in younger children than in adults? A retrospective study of 33 cases of childhood melanoma from a single institution.

Background. Malignant melanoma in childhood is rare. As a result, the biology and natural history of melanoma in this age group is still poorly understood. Although the majority of Spitz nevi are benign regardless of atypical features, a particular problem is the continued confusion of Spitz nevi with atypical features with melanoma and the lack of specific criteria for their distinction. The latter discrimination is perhaps not so difficult when Spitz nevi are minimally atypical; however, the greater the atypia, the more challenging is this discrimination.



Methods. All cases of malignant melanoma referred to Children's Hospital (Boston, MA) and to one of the authors were examined during the period of 1959–1995. Criteria for inclusion in the study included: (1) age up to 15 years; (2) availability of microscopic slides; and (3) availability of demographic data.



Results. There were 11 males and 12 females, ranging in age from 2 to 15 years (mean age, 9.4 years). Histopathologically, the 23 tumors were categorized into four subgroups: (1) small cell melanoma (5); (2) adult-like melanoma (6); (3) Spitz-like melanoma (3), and (4) atypical Spitz tumors (9). The small cell melanomas were notable for localization to the scalp, significant thickness, and fatal outcome. The adult-like melanomas resembled typical tumors occurring in adults. The one fatal Spitz-like melanoma was located on the neck of a 14-year-old male. Two tumors in this group metastasized to regional lymph nodes, but were not associated with further aggressive disease on follow-up despite treatment with surgical excision only. The atypical Spitz tumors were characterized by significant thickness and abnormal features including prominent cellularity and mitotic activity.



Conclusions. Anatomic site and cell type may be important prognostic factors in addition to tumor thickness for childhood melanoma, but these tumors require further study. In addition, the biologic potential of atypical Spitz tumors has not been characterized sufficiently. Cancer 1995; 76:1833–45.

Cutaneous melanoma and atypical spitz tumors in childhood

To give a child the ominous diagnosis of malignant melanoma is a very difficult decision for both clinician and pathologist. Difficulties in histologic diagnosis combined with a reluctance on the part of the clinician may lead to delays in diagnosis and curative surgical intervention. In fact, some melanomas in children are misdiagnosed clinically as benign lesions and recognized as melanomas only after excision. It is imperative to recognize that malignant melanoma occurs in children and to appreciate its clinical characteristics and predisposing factors. Incidence and Prognosis Approximately 2 percent of melanomas occur in patients under the age of 20 years, . . .

Melanoma in children.

Since the entity of "juvenile melanoma" was first described, many pathologists have been reluctant to diagnose malignant melanoma in childhood by pathologic criteria alone. In this series of 125 cases, pathologic criteria are used to distinguish malignant melanoma of childhood from spindle and epithelioid nevus. Among the patients reviewed, 110 cases (86%) occurred between ages 13 and 20 years, and 15 cases (14%) in children under 12. There were 60 males (54%) and 50 females (46%) in the older age group, and six males (41%) and nine females (59%) in the childhood group. In the 13 to 20 age group, there were 24% head and neck primary melanomas, 38% truncal primaries, 30% limb primaries, and 7% indeterminate, as opposed to 35% head and neck, 23% truncal, and 41% limb in the group under 12. In the 13 to 20 year group, 66% were stage I, 11% stage II, 12% stage III, 2% stage IV and 7% indeterminate while in the 12 and under group, 76% were stage I, 12% stage III, and 12% stage IV. Mortality rates were 49% for the 13 to 20 year group and 60% for the 12 and under group.

J. Smith

Papers

Malignant melanoma in children and young adults: effect of diagnostic criteria on staging and end results.

A comparison between reciprocal crosses of Australorps and White Leghorns.

Hereditary aspects of malignant melanoma