Afanasiev Olga K, Tu Joanna H, Chu Derek H, Swetter Susan M
Department of Dermatology, Stanford University Medical Center, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Lucile Packard Children's Hospital, Stanford, California.
Dermatology Service, VA Palo Alto Health Care System, Palo Alto, California.
Pediatr Dermatol. 2019 Jul;36(4):448-454. doi: 10.1111/pde.13836. Epub 2019 Apr 16.
To characterize clinical differences among nonwhite/multiethnic vs white children, adolescents, and young adults with melanoma or atypical melanocytic neoplasms, including atypical Spitz tumors.
A cohort of 55 patients (< 25 years of age) prospectively followed from 1995 to 2018 in the Stanford Pigmented Lesion and Melanoma Program was analyzed for differences in clinical presentation, including skin phototype, race/ethnicity, age, sex, tumor/melanoma characteristics, and outcome.
Seventeen patients (9 males and 8 females) were classified as nonwhite (predominantly skin phototype IV) and of Hispanic, Asian, or Black/African American ethnicity, and 38 patients (21 males and 17 females) were classified as white (predominantly phototypes I/II). Ages ranged from 6 months to 24 years, and median follow-up was 36 months (range 1-180 months). Melanomas were diagnosed in 87% of whites in our cohort, compared to 65% of nonwhites, with the remainder representing mainly atypical Spitz tumors. Lesions were usually brought to the attention of a health care provider by the patient or family (P < 0.05). Compared with whites, nonwhites were more likely to present at a younger mean age (10.9 years vs 15.4 years, P < 0.05) and with pink/clinically amelanotic tumors (59% vs 24%, P = 0.02).
This long-term prospective institutional study showed clinically relevant differences between nonwhite vs white children, adolescents, and young adults diagnosed with melanoma and atypical melanocytic neoplasms. Nonwhite patients presented at a younger age and had more clinically amelanotic melanocytic tumors. Increased recognition of clinical factors and risk of these tumors in nonwhites could result in earlier diagnosis.
描述患有黑色素瘤或非典型黑素细胞肿瘤（包括非典型斯皮茨瘤）的非白人/多民族与白人儿童、青少年及年轻成人之间的临床差异。
对1995年至2018年在斯坦福色素沉着病变与黑色素瘤项目中前瞻性随访的55例年龄小于25岁的患者进行队列分析，以探讨临床表现的差异，包括皮肤光型、种族/民族、年龄、性别、肿瘤/黑色素瘤特征及预后。
17例患者（9例男性和8例女性）被归类为非白人（主要为皮肤光型IV），种族为西班牙裔、亚裔或黑人/非裔美国人，38例患者（21例男性和17例女性）被归类为白人（主要为光型I/II）。年龄范围为6个月至24岁，中位随访时间为36个月（范围1 - 180个月）。在我们的队列中，87%的白人被诊断为黑色素瘤，相比之下非白人的这一比例为65%，其余主要为非典型斯皮茨瘤。病变通常是由患者或家属引起医护人员的注意（P < 0.05）。与白人相比，非白人更可能在更年轻的平均年龄就诊（10.9岁对15.4岁，P < 0.05），且出现粉色/临床无色素肿瘤的比例更高（59%对24%，P = 0.02）。
这项长期的前瞻性机构研究显示，被诊断患有黑色素瘤和非典型黑素细胞肿瘤的非白人与白人儿童、青少年及年轻成人之间存在临床相关差异。非白人患者就诊年龄更小，且临床无色素黑素细胞肿瘤更多。提高对非白人中这些肿瘤临床因素及风险的认识可能会导致更早的诊断。
