Pediatric Melanoma Treatment
Knowing your child’s stage of diagnosis is important so the best treatment plan can be put into place. It is important to know that you have choices when it comes to where to seek treatment for your child. Not all treatment centers follow the same protocol for treating pediatric melanoma. It is important that you gather all the facts and make your decision based on what is best for your family. To get you started use our Treatment Center Finder.
Surgery – a wide excision of the tumor – is the most common treatment for melanoma. The surgeon removes the melanoma and the surrounding tissue. The thickness of the melanoma will determine the amount of tissue removed and whether the surgery is an in- or out-patient procedure. A local anesthesia will likely be used. The severity of the scar will depend on the size, depth and location of the tumor.
Whereas early stage melanomas usually just need observation after surgery, thicker melanomas, or those that have spread to the lymph nodes, may require additional treatment. In the case of a thicker or ulcerated melanoma, your surgical oncologist will likely discuss two procedures: lymphatic mapping and sentinel lymph node (SLN) biopsy. If the SLN is cancer free, then no other lymph nodes will need to be checked or removed. If the SLN contains melanoma, your doctor may discuss further surgery and additional treatment.
Regional Lymph Node Metastasis
If melanoma has spread to the regional lymph nodes, a surgical procedure known as lymph node dissection is often performed. This procedure consists of removal of the “compartment” of lymph nodes related to the location of where the tumor-containing lymph node was identified. This procedure is performed under general anesthesia; one or more drain tubes are usually placed at the completion of surgery to facilitate recovery.
As pediatric melanoma is rare, generating knowledge, designing clinical trials and developing effective treatments is a challenge. To gain FDA approval, a treatment generally must first demonstrate efficacy in adults. It will then undergo a complex process to determine dosing and how it will interact with a child’s body, and then an estimation on how similar the response will be between an adult and a child.
On July 24, 2017, the FDA approved the immunotherapy ipilimumab, also known as Yervoy, for patients ages 12 years and older with unresectable or metastatic melanoma. Ipilimumab is a checkpoint inhibitor that was first approved in 2011 for the treatment of adults with melanoma in both the unresectable or metastatic setting as well as an adjuvant therapy after complete removal of the tumor.
Some Stage IV pediatric melanoma patients have used other immunotherapies that have been approved by the FDA for adult patients. These options should be discussed with your child’s oncologist.
Clinical trials are sometimes viewed as the best treatment option for adult melanoma patients. For children with melanoma, especially those with recurrent or Stage IV disease, clinical trials may be appropriate to consider. As with all treatment options, clinical trials should be discussed thoroughly with your child’s oncologist.
A 2014 study published in the Journal of Investigative Dermatology provided a comprehensive genomic analysis of pediatric melanoma – finding unique genomic features for each of the three subtypes of pediatric melanoma – and suggests compelling evidence that UV exposure may play more of a role than initially thought in this disease. The data from this study suggest that therapeutic targets for genotype-specific (such as BRAF) melanoma in adults might also be applicable to pediatric patients.