Al-Himdani Sarah, Naderi N, Whitaker I S, Jones N W
Welsh Centre for Burns and Plastic Surgery, Swansea, United Kingdom.
Plast Reconstr Surg Glob Open. 2019 Aug 30;7(8):e2338. doi: 10.1097/GOX.0000000000002338. eCollection 2019 Aug.
Malignant melanoma is rare in childhood and adolescence. Diagnostic uncertainty and misdiagnosis often lead to delayed treatment.
We evaluated children and adolescents under 20 years of age presenting with malignant melanoma at our institution over an 18-year period. Data were collected, analyzed, and interpreted, following which findings were compared with the existing literature.
Twenty-four patients were included in the study with mean follow-up of 61.8 months. Males comprised 54% of cases. On presentation, 33% of children had melanoma of s thickness 2-4 mm and 34% had stage III disease. Younger children presented with thicker melanomas, differing subtypes, and more advanced stage disease compared with older children. Extremities were the most common sites affected (42%). Dissection of the draining lymph node basins was undertaken in 38% of cases. Overall survival was 92%.
Tumor subtype, biology, hormonal influence, and lymph node status are all important prognostic factors in malignant melanoma in childhood and adolescence. Compared with adults, children presenting with thicker melanomas and more advanced stage disease generally have more favorable outcomes and a better survival. Plastic surgeons, commonly encountering skin lesion in children, must maintain a high index of suspicion so that early excision and sentinel lymph node biopsy may be promptly offered to patients with melanoma.
恶性黑色素瘤在儿童和青少年中较为罕见。诊断的不确定性和误诊常常导致治疗延迟。
我们评估了在18年期间于我院就诊的20岁以下患有恶性黑色素瘤的儿童和青少年。收集、分析并解读数据，随后将结果与现有文献进行比较。
24名患者纳入研究，平均随访61.8个月。男性占病例的54%。就诊时，33%的儿童黑色素瘤厚度为2 - 4毫米，34%患有III期疾病。与年龄较大的儿童相比，年龄较小的儿童黑色素瘤更厚，亚型不同，疾病分期更晚。四肢是最常受累的部位（42%）。38%的病例进行了引流淋巴结区域清扫。总生存率为92%。
肿瘤亚型、生物学特性、激素影响和淋巴结状态都是儿童和青少年恶性黑色素瘤重要的预后因素。与成人相比，黑色素瘤更厚且疾病分期更晚的儿童通常预后更好，生存率更高。整形外科医生在儿童中常遇到皮肤病变，必须保持高度警惕，以便能及时为黑色素瘤患者提供早期切除和前哨淋巴结活检。
