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Melanoma in Children and Teenagers: An Analysis of Patients From the National Cancer Data Base

Julie R. Lange, Bryan E. Palis, David C. Chang, Seng-Jaw Soong, Charles M. Balch

From the Department of Surgery, Johns Hopkins Medicine, Baltimore, MD; The National Cancer Data Base, American College of Surgeons, Chicago, IL; and the Biostatistics and Bioinformatics Unit, University of Alabama School of Medicine, Birmingham, AL

Address reprint requests to Julie R. Lange, MD, ScM, 600 N Wolfe St, Carnegie 681, Baltimore, MD 21287; e-mail: jlange{at}jhmi.edu

Purpose This study examines the demographics, presentation, and outcomes of children and teenagers with melanoma using a US hospital-based oncology database.

Patients and Methods Data from the National Cancer Data Base from 1985 through 2003 were examined for demographics, presentation, and survival of patients aged 1 to 19 years, as well as a comparison group of patients aged 20 to 24 years. Two-sided linear and Pearson ² tests were calculated to examine associations. Proportions were compared using two-sided z tests. Five-year overall observed survival was evaluated using the Kaplan-Meier method and the log-rank test. Cox proportional hazards regression was used to estimate risk of mortality.

Results Of 3,158 patients aged 1 to 19 years, 96.3% had cutaneous melanoma, 3.0% had ocular melanoma, and 0.7% had an unknown primary tumor. Cutaneous melanoma in patients aged 1 to 19 years was more common in girls (55.5%) and patients older than 10 years (90.5%). The demographics and presentation of cutaneous melanoma were age related; younger children were significantly more likely to be nonwhite and male and more likely to present with a head and neck primary tumors and with regional or distant metastases (linear ², P < .001 for sex, race, and extent of disease). Poorer survival was associated with higher stage and younger age. In contrast to patients aged 20 to 24 years, survival was not related to thickness in patients aged 1 to 19 years with localized invasive melanoma.

Conclusion Melanoma in children and teenagers differs from melanoma in young adults in demographics, presentation, and survival. Further investigation is warranted to elucidate possible biologic correlates of the unique aspects of melanoma in children and teenagers.

Presented in part at the 6th World Melanoma Congress, September 6-10, 2005, Vancouver, British Columbia, Canada.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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