Pediatric Melanoma Risk Increasing in Adolescents & Young Adults, Including in Non-Whites Interview with:

Susan M. Swetter, MDProfessor of DermatologyDirector, Pigmented Lesion & Melanoma ProgramPhysician Leader, Cancer Care Program in Cutaneous OncologyStanford University Medical Center and Cancer Institute

Dr. Swetter

Susan M. Swetter, MD
Professor of Dermatology
Director, Pigmented Lesion & Melanoma Program
Physician Leader, Cancer Care Program in Cutaneous Oncology
Stanford University Medical Center and Cancer Institute What is the background for this study? What are the main findings? 

Response: The Stanford Pigmented Lesion and Melanoma and Program and Pediatric Dermatology Division participated in the long-term management of children, adolescents and young adults (<25 years of age) with melanoma and atypical melanocytic neoplasms, including atypical Spitz tumors (ASTs) that may be histopathologically challenging to differentiate from true melanoma.

Over a 23-year period, we have observed increased racial-ethnic diversity in young patients with these diagnoses, especially in the presentation of young individuals with darker skin phenotypes and more clinically amelanotic (nonpigmented) lesions compared to patients with lighter skin. What should readers take away from your report?

Response: While most melanomas occur in light-complexioned individuals (Fitzpatrick skin phototypes I-III), the burden of melanoma is growing in those with darker skin, particularly Hispanics. Of 55 young individuals diagnosed with melanoma and atypical melanocytic neoplasms, 17 were classified as non-white (predominantly phototype IV) and 38 as white (predominantly phototypes I/II). The proportion of melanoma diagnoses was higher in whites compared to non-whites (87% vs 65%, respectively), with the rest classified mainly as ASTs. However, non-whites were more likely to present with tumors on the extremities, at a younger age (10.9 years vs 15.4 years), and with clinically amelanotic (pink or flesh-colored) skin lesions (59% vs 24%) compared with whites. What recommendations do you have for future research as a result of this work? 

Response: Although pediatric melanoma is rare, the incidence is rising among adolescents and young adults. Increased recognition of melanoma risk in young individuals with darker skin phenotypes and how clinical warning signs may differ compared to lighter-skinned individuals (including younger age of onset and more clinically amelanotic lesions) may improve early detection and patient outcomes. Ongoing research of pediatric melanoma and atypical melanocytic neoplasms through large, collaborative, prospective data sets will help to understand differences of melanoma subtypes and prognosis by age, race/ethnicity, and other factors.

No disclosures to report. 


Characteristics of melanoma in white and nonwhite children, adolescents, and young adults: Analysis of a pediatric melanoma institutional registry, 1995-2018
Pediatric Dermatology — Afanasiev OK, et al. | April 18, 2019


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