Pediatric Melanoma in the Hispanic Population Pediatric Dermatology

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• In this cross-sectional study, the authors evaluated patient and tumor characteristics of melanomas diagnosed in pediatric Hispanic patients from a single institution and compared them with those for melanomas diagnosed in non Hispanic White patients. Hispanic patients were significantly younger in age (mean age at diagnosis, 11.7 years; P = .001) and had a lower-limb predominance (46%; P < .05). Tumor characteristics included increased spitzoid melanomas (82%; P < .05) and thicker tumors (mean Breslow depth, 2.34 mm; P < .05). These findings were reproduced when Hispanic and non-Hispanic White patients with pediatric melanoma from the Surveillance, Epidemiology, and End Results Program database were compared.

• Hispanics represent the fastest growing minority in the United States, and the incidence of melanoma in this population is also rising. A lower threshold for biopsy of a spitzoid tumor on the lower limb of a Hispanic patient may be warranted based on the findings of this study.

– Margaret Hammond, MD

Written by

 

 

Claudia Hernandez MD

Written by

 

 

Kayla A. Clark BS

The study by Kim et al provides important data regarding differences between Hispanic pediatric melanoma patients (HPMP) versus non-Hispanic White melanoma pediatric patients (NHMP). Their single-institutional data review from 1988 to 2016 of melanoma patients under 20 years of age found that HPMP were diagnosed at a younger (mean) age than their NHMP counterparts, with thicker tumors, lower limb predominance, and a greater proportion of spitzoid melanomas. Clinical findings were described as a "bump" (9/11 cases), "some erythema" (6/11 cases), and "uniform erythema" (2/11 cases). This supports findings by other investigators who described "modified" ABCD criteria among pediatric melanoma patients as erythematous nodular/polypoid tumors were common presentations of spitzoid melanomas. The authors also reviewed SEER data (same time frame) and found similar findings in regard to age, tumor thickness, spitzoid subtype, and lower limb location.

Hispanic adults often present with more advanced melanoma than their non-Hispanic White counterparts, and this study demonstrates that this trend does not spare Hispanic children. These findings point to the urgent need to re-examine current skin cancer education for different skin types and realign education programs for physicians and the public alike. A rigorous re-examination of the ABCD criteria should be performed to determine what modifications are necessary to increase its sensitivity in specific populations. Studies should examine whether acute changes such as enlargement are important clinical features of melanoma subtypes that preferentially affect both adults and children of color. These studies would form the basis for evidence-based changes to the ABCD criteria for different skin types and reduce the risk of its misapplication leading to diagnostic delays.

Public education campaigns must include Hispanic adolescents and adults who may perceive themselves as having little to no skin cancer risk. This may influence their decision not to seek out skin cancer screening or practice prevention. This article raises our awareness of the need to also develop targeted campaigns for Hispanic parents since even very young Hispanics appear at risk for shouldering the burden of advanced melanoma.

Abstract 

BACKGROUND/OBJECTIVES

Pediatric melanoma is rare and remains poorly characterized, especially in racial/ethnic minorities of whom Hispanics are the largest and fastest growing in the United States. The health care burden of melanoma in Hispanics, who often present with more advanced disease, is rising and has even been called an early epidemic in California. We sought to document key clinicopathologic features of melanoma in Hispanic pediatric patients and to compare these parameters to pediatric non-Hispanic whites (NHWs) under the a priori hypothesis that Spitzoid melanomas occur in greater proportions in Hispanics.

METHODS

Single-institution cross-sectional study of pediatric melanoma cases (age < 20 years) with Hispanic stratification and comparison with matched Surveillance, Epidemiology, and End Results (SEER) data from the same time frame (1988-2016).

RESULTS

Of our 61 institutional cases of pediatric melanoma, Hispanics (11), compared with NHWs (40), presented significantly younger (11.7 years, 95% CI: 2.77-8.00 years; P = .001), with lower limb predominance (46%; P < .05), mostly Spitzoid melanomas (82%; P < .05), and thicker tumors (2.34 mm, CI: 0.26-2.19 mm; P < .05). Similarly, SEER data (2499 cases) showed greater proportions of childhood/pre-pubertal adolescent melanomas (<15 years), lower limb involvement, Spitzoid subtype (36.5% vs 22.5% in NHWs; P = .001), and advanced (regional/distant) disease stages in Hispanics (212) compared with NHWs (2197).

CONCLUSIONS

Pediatric melanomas may present differently in Hispanics, and heightened awareness/lower threshold to biopsy high-risk Spitzoid tumors on the lower limb may be warranted. Further investigations are needed to aid prevention and early detection in a vulnerable minority population less likely to seek outpatient dermatology specialty care.

Pediatric Dermatology

Pediatric Melanoma in the Hispanic Population: An Analysis of Institutional and National Data

Pediatr Dermatol 2021 Jan 24;[EPub Ahead of Print], DJ Kim, TA Yuan, PC Chen, F Liu-Smith, SS Koh, NA Mesinkovska, HG Sarpa

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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