Predictors of Nodal Metastases in Pediatric Melanomas

Pediatric melanomas are a rare and deadly form of skin cancer. Melanomas in adults have better studied than the pediatric variant due to the rarity of melanomas arising in children. Most of the information available about pediatric melanomas are from smaller studies, and the medical literature is sparse on information about factors that are associated with more aggressive disease. Disease staging is an important predictor for how long a patient is expected to live. Patients with localized disease generally have better outcomes than those with advanced disease that have spread to the brain, lungs, liver, among other organs. In adults, staging criteria are well defined, and factors such as tumor size, how deep a tumor invades into the tissue, and how a tumor looks under the microscope, have been helpful in identifying whether a melanoma will behave aggressively and spread to distant tissues. In children, these factors are well less defined given the rarity of the disease, and current studies suggest that pediatric melanomas may behavior differently than those that arise in adults. Our study aims to use a national database of pediatric melanoma patients to address these uncertainties in the medical literature. We performed a preliminary analysis that demonstrates that different subtypes of pediatric melanomas behave differently. We demonstrate that epithelioid/spindle cell and melanoma arising from a previous mole are more aggressive than other subtypes. We additionally found that nodular melanoma and epithelioid/spindle cell subtypes have higher rates of having metastatic disease. In our study, we aim to identify high-risk features that increase the probability of a child developing metastatic melanoma. We additionally want to create a risk calculator to help clinicians quantify this risk to help them decide as to whether a child with melanoma requires further studies, such as lymph node evaluation or clinical imaging to assess whether advanced disease is present.