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Pampena R, Piccolo V, Muscianese M, Kyrgidis A, Lai M, Russo T, Briatico G, Di Brizzi EV, Cascone G, Pellerone S, Longo C, Moscarella E, Argenziano G. Melanoma in children: A systematic review and individual patient meta-analysis. J Eur Acad Dermatol Venereol 2023; 37:1758-1776. [PMID: 37210654 DOI: 10.1111/jdv.19220] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/07/2023] [Indexed: 05/22/2023]
Abstract
The current evidence on paediatric melanoma is heterogeneous, especially regarding the prognosis of different histological subtypes. We sought to systematically review the evidence on paediatric melanoma, highlighting the major sources of heterogeneity and focusing on available data on single patients. A systematic search was performed from 1948 to 25 January 2021. Only studies reporting at least one case of cutaneous melanoma in patients aged ≤18 years were included. Unknown primary and uncertain malignant melanomas were excluded. Three couples of authors independently performed title/abstract screening and two different authors reviewed all the relevant full texts. The selected articles were manually cross-checked for overlapping data for qualitative synthesis. Subsequently data on single patients were extracted to perform a patient-level meta-analysis. PROSPERO registration number: CRD42021233248. The main outcomes were melanoma-specific survival (MSS) and progression-free survival (PFS) outcomes. Separate analyses were done of cases with complete information on histologic subtype, focusing on superficial spreading (SSM), nodular (NM) and spitzoid melanomas, as well as of those classified as de-novo (DNM) and acquired or congenital nevus-associated melanomas (NAM). The qualitative synthesis covered 266 studies; however, data on single patients were available from 213 studies including 1002 patients. Among histologic subtypes, NM had a lower MSS than both SSM and spitzoid melanoma, and a lower PFS than SSM. Spitzoid melanoma had a significantly higher progression risk than SSM and trended toward lower mortality. Focusing on nevus-associated status, DNM demonstrated better MSS after progression than congenital NAM, and no differences were highlighted in PFS. Our findings describe the existence of different biological patterns in paediatric melanoma. Specifically, spitzoid melanomas demonstrated intermediate behaviour between SSM and NM and showed a high risk of nodal progression but low mortality. This raises the question of whether spitzoid lesions are being over-diagnosed as melanoma in childhood.
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Affiliation(s)
- Riccardo Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Athanassios Kyrgidis
- Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michela Lai
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Teresa Russo
- Dermatology Unit, University of Campania, Naples, Italy
| | | | | | | | | | - Caterina Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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de Campos Vieira Abib S, Chui CH, Cox S, Abdelhafeez AH, Fernandez-Pineda I, Elgendy A, Karpelowsky J, Lobos P, Wijnen M, Fuchs J, Hayes A, Gerstle JT. International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines. Ecancermedicalscience 2022; 16:1356. [PMID: 35510137 PMCID: PMC9023308 DOI: 10.3332/ecancer.2022.1356] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Indexed: 12/14/2022] Open
Abstract
Most children with tumors will require one or more surgical interventions as part of the care and treatment, including making a diagnosis, obtaining adequate venous access, performing a surgical resection for solid tumors (with staging and reconstruction), performing procedures for cancer prevention and its late effects, and managing complications of treatment; all with the goal of improving survival and quality of life. It is important for surgeons to adhere to sound pediatric surgical oncology principles, as they are closely associated with improved local control and survival. Unfortunately, there is a significant disparity in survival rates in low and middle income countries, when compared to those from high income countries. The International Society of Paediatric Surgical Oncology (IPSO) is the leading organization that deals with pediatric surgical oncology worldwide. This organization allows experts in the field from around the globe to gather and address the surgical needs of children with cancer. IPSO has been invited to contribute surgical guidance as part of the World Health Organization Initiative for Childhood Cancer. One of our goals is to provide surgical guidance for different scenarios, including those experienced in High- (HICs) and Low- and Middle-Income Countries (LMICs). With this in mind, the following guidelines have been developed by authors from both HICs and LMICs. These have been further validated by experts with the aim of providing evidence-based information for surgeons who care for children with cancer. We hope that this initiative will benefit children worldwide in the best way possible. Simone Abib, IPSO President Justin T Gerstle, IPSO Education Committee Chair Chan Hon Chui, IPSO Secretary.
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Affiliation(s)
- Simone de Campos Vieira Abib
- Pediatric Oncology Institute, GRAACC, Federal University of São Paulo, Rua Pedro de Toledo, 572 - Vila Clementino, São Paulo, SP 04021-001, Brazil
| | - Chan Hon Chui
- Surgery Centre for Children, Mount Elizabeth Medical Centre, 3 Mount Elizabeth, 228510, Singapore
| | - Sharon Cox
- Division of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Abdelhafeez H Abdelhafeez
- Department of Surgery, St Jude Research Hospital 262 Danny Thomas Place. MS133, Memphis, TN 38105, USA
| | - Israel Fernandez-Pineda
- Department of Pediatric Surgery, Virgen del Rocio Children’s Hospital, Av Manuel Siurot S/NN, Sevilla 41013, Spain
| | - Ahmed Elgendy
- Surgical Oncology Unit, Faculty of Medicine, Tanta University, Elgiesh Street, 31111, Tanta, Gharbeya, Egypt
| | - Jonathan Karpelowsky
- Department of Paediatric Surgery, Children’s Hospital at Westmead, Westmead NSW 2145, Australia
| | - Pablo Lobos
- Pediatric Surgery Division, Hospital Italiano de Buenos Aires, Andrés Lamas 812, Buenos Aires 1406, Argentina
| | - Marc Wijnen
- Department of Surgery, Princess Maxima Center for Pediatric Oncology, Huispostnummer KE 01.129.2, Postbus 85090, Utretcht 3508AB, The Netherlands
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University of Tuebingen, Hoppe-Seyler-Str. 3, Tübingen 72076, Germany
| | - Andrea Hayes
- Department of Surgery, Howard University Hospital, 1851 9th Street NW, 4th Floor, Washington, DC 20059, USA
| | - Justin T Gerstle
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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