30 Aug Fatal Pediatric Melanoma is Rare But Diverse

MedicalResearch.com Interview with:
Elena B. Hawryluk, MD, PhD
Board-certified Dermatologist and Pediatric Dermatologist
Assistant Professor of Dermatology
Harvard Medical School
Faculty Director of Pediatric Dermatology
Harvard Combined Dermatology Residency Program.

Dr. Hawryluk sees patients at Massachusetts General Hospital and Boston Children’s Hospital, and has a clinical interest in pigmented lesions and melanoma in the pediatric population.
Dr. Hawryluk is a member of the Society for Pediatric Dermatology.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Melanoma is exceptionally rare and challenging to diagnose in the pediatric population.  The most important and clearly defined patients with melanoma are those with an aggressive fatal course, so this study was pursued to evaluate fatal presentations to help physicians to recognize those patients at highest risk.  Due to the rarity of fatal pediatric melanoma, in order to study a big enough group, our research team included pediatric dermatologists who collaborated from major institutions across the US and Canada, through the Pediatric Dermatology Research Alliance (PeDRA). 

MedicalResearch.com: Were there any characteristics that might help distinguish these fatal moles?  Were the children immunocompromised in any way? Were they sun-related since the children were so young?

Response: One of the most striking findings was that fatal melanoma can present very diversely, from the youngest children to adolescents, and in a variety of subtypes – from infants with a large congenital birthmark to adolescents who have more opportunities for sun exposure.

The number of cases, even across several decades and many large academic centers, was so low that a clear pattern of presentation was not appreciated. 

MedicalResearch.com: What should readers take away from your report?

Response: First, that fortunately fatal pediatric melanoma is exceptionally rare.  Also, we were unable to identify a pre-pubertal diagnosis of spitzoid melanoma that had a fatal outcome, which is very reassuring for the youngest patients with this diagnosis.  Lastly, that a fatal outcome is possible among diverse clinical presentations of melanoma in the pediatric population.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Given the challenges associated with a diagnosis of melanoma and the rarity of the diagnosis, I recommend additional research studies to evaluate the ancillary genetic studies that can be used in the diagnosis of challenging pigmented lesions, specifically in the pediatric population.  It is very exciting to have genetic tools including fluorescence in situ hybridization, array comparative genomic hybridization, whole exome sequencing, and others that have been utilized in the evaluation of adult tumors to distinguish malignant and benign lesions.  It is important to understand the value of these tests for pediatric tumors before using them broadly to make a diagnosis in this population.

MedicalResearch.com: Is there anything else you would like to add?

Response: The pediatric population is special when it comes to new and changing pigmented lesions.  In children, new and changing pigmented lesions are commonplace with lesion onset and significant patient growth.  The features that are concerning for melanoma in adults (often termed the ABCDEs to signify asymmetry, border irregularity, color diversity, diameter, and evolution) are not as helpful in the pediatric population, and sometimes lesions that appear to be unusual are not dangerous.  For any new or changing pigmented lesion of concern, it is important to seek evaluation by a board-certified dermatologist or pediatric dermatologist to identify whether additional testing is needed.  Sun protection and prevention of sunburns is very important for pediatric patients to reduce their lifetime risk of melanoma and skin cancer.   

About the Pediatric Dermatology Research Alliance (PeDRA)

Formed in 2012, the Pediatric Dermatology Research Alliance (PeDRA) is a nonprofit research organization that includes more than 300 members and supports vibrant research and educational programs. PeDRA’s mission is to create, inspire, and sustain research to prevent, treat, and cure childhood skin disease.  For more on PeDRA visit https://pedraresearch.org.

Citation:

Elena B. Hawryluk, Danna Moustafa, Diana Bartenstein, Meera Brahmbhatt, Kelly Cordoro, Laura Gardner, Abigail Gauthier, Douglas Grossman, Deepti Gupta, Raegan D. Hunt, Melinda Jen, Pei-Chi Kao, Lacey L. Kruse, Leslie P. Lawley, Wendy B. London, Danny Mansour, Judith A. O’Haver, Thuy Phung, Elena Pope, Harper N. Price, Tova Rogers, Sonal D. Shah, Zachary Wolner, Jennifer Huang, Ashfaq A. Marghoob,

A Retrospective Multicenter Study of Fatal Pediatric Melanoma,

Journal of the American Academy of Dermatology, 2020

https://www.sciencedirect.com/science/article/abs/pii/S0190962220321101 

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Last Updated on August 30, 2020 by Marie Benz MD FAAD