Chao Mwe Mwe, Schwartz Jennifer L, Wechsler Daniel S, Thornburg Courtney D, Griffith Kent A, Williams James A
Department of Pediatric Hematology-Oncology, University of Michigan Health System, Ann Arbor, Michigan 48109-0936, USA.
Pediatr Blood Cancer. 2005 May;44(5):441-8. doi: 10.1002/pbc.20168.
Pediatric patients with high-risk surgically resected melanoma are at risk for relapse, yet little is known about these young patients and how they tolerate high-dose interferon therapy.
We reviewed medical records of patients (< or =18 years) with high-risk melanoma referred to the University of Michigan Pediatric Hematology-Oncology service between January 1989 and July 2003.
Fourteen patients were identified with high-risk resected melanoma. The median age at diagnosis was 8.5 years. The median time to establish diagnosis was 9 months. Primary lesions were diagnosed as unequivocal melanoma, atypical epithelioid melanocytic proliferations, or atypical Spitz tumor with indeterminate malignant potential. Twelve patients had a positive sentinel lymph node (SLN) biopsy or a palpable regional lymph node and underwent regional lymph node dissection (LND). Two patients with unequivocal melanoma with Breslow depth >4 mm had negative SLN biopsies. Twelve patients received adjuvant high-dose interferon. The following toxicities were observed: constitutional symptoms, gastrointestinal symptoms, depression or neuropsychiatric symptoms, myelosuppression, elevated AST or ALT, hypothyroidism, and hypertension. Grade 3 or 4 toxicities were uncommon with exception of neutropenia, resulting in modification of therapy in one patient. All patients are alive and free of disease at follow-up (median 24.5 months).
Invasive melanoma can occur in very young children. Despite early signs of malignancy, there is often a delay in diagnosis. Histologically, diagnosis may be difficult because of overlap with Spitz nevi. Pediatric patients tolerated adjuvant high-dose interferon well and may be less likely than adults to require therapy modification secondary to toxicities.
接受高风险手术切除的小儿黑色素瘤患者有复发风险，但对于这些年轻患者以及他们如何耐受高剂量干扰素治疗知之甚少。
我们回顾了1989年1月至2003年7月间转诊至密歇根大学儿科血液肿瘤服务中心的高危黑色素瘤患者（年龄≤18岁）的病历。
确定了14例高危切除性黑色素瘤患者。诊断时的中位年龄为8.5岁。确诊的中位时间为9个月。原发性病变诊断为明确的黑色素瘤、非典型上皮样黑素细胞增生或具有不确定恶性潜能的非典型斯皮茨瘤。12例患者前哨淋巴结活检阳性或可触及区域淋巴结，并接受了区域淋巴结清扫术（LND）。2例Breslow深度>4 mm的明确黑色素瘤患者前哨淋巴结活检阴性。12例患者接受了辅助高剂量干扰素治疗。观察到以下毒性反应：全身症状、胃肠道症状、抑郁或神经精神症状、骨髓抑制、AST或ALT升高、甲状腺功能减退和高血压。除中性粒细胞减少外，3级或4级毒性反应不常见，1例患者因此调整了治疗方案。所有患者随访时均存活且无疾病（中位随访时间24.5个月）。
侵袭性黑色素瘤可发生于幼儿。尽管有早期恶性迹象，但诊断往往延迟。在组织学上，由于与斯皮茨痣重叠，诊断可能困难。小儿患者对辅助高剂量干扰素耐受性良好，且因毒性反应而需要调整治疗的可能性可能低于成人。
