Evaluation and Surgical Management of Pediatric Cutaneous Melanoma and Atypical Spitz and Non-Spitz Melanocytic Tumors (Melanocytomas): A Report From Children's Oncology Group.

IF 42.1 1区 医学 Q1 ONCOLOGY Journal of Clinical Oncology Pub Date : 2025-03-20 Epub Date: 2024-10-04 DOI:10.1200/JCO.24.01154
Michael R Sargen, Raymond L Barnhill, David E Elder, Susan M Swetter, Victor G Prieto, Jennifer S Ko, Armita Bahrami, Pedram Gerami, Arivarasan Karunamurthy, Alberto S Pappo, Lynn M Schuchter, Philip E LeBoit, Iwei Yeh, John M Kirkwood, Melinda Jen, Ira J Dunkel, Megan M Durham, Emily R Christison-Lagay, Mary T Austin, Jennifer H Aldrink, Casey Mehrhoff, Elena B Hawryluk, Emily Y Chu, Klaus J Busam, Vernon Sondak, Jane Messina, Susana Puig, Andrew J Colebatch, Carrie C Coughlin, Kristen G Berrebi, Theodore W Laetsch, Sarah G Mitchell, Brittani Seynnaeve
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Abstract

Purpose: The purpose of this study was to develop recommendations for the diagnostic evaluation and surgical management of cutaneous melanoma (CM) and atypical Spitz tumors (AST) and non-Spitz melanocytic tumors (melanocytomas) in pediatric (age 0-10 years) and adolescent (age 11-18 years) patients.

Methods: A Children's Oncology Group-led panel with external, multidisciplinary CM specialists convened to develop recommendations on the basis of available data and expertise.

Results: Thirty-three experts from multiple specialties (cutaneous/medical/surgical oncology, dermatology, and dermatopathology) established recommendations with supporting data from 87 peer-reviewed publications.

Recommendations: (1) Excisional biopsies with 1-3 mm margins should be performed when feasible for clinically suspicious melanocytic neoplasms. (2) Definitive surgical treatment for CM, including wide local excision and sentinel lymph node biopsy (SLNB), should follow National Comprehensive Cancer Network Guidelines in the absence of data from pediatric-specific surgery trials and/or cohort studies. (3) Accurate classification of ASTs as benign or malignant is more likely with immunohistochemistry and next-generation sequencing. (4) It may not be possible to classify some ASTs as likely/definitively benign or malignant after clinicopathologic and/or molecular correlation, and these Spitz tumors of uncertain malignant potential should be excised with 5 mm margins. (5) ASTs favored to be benign should be excised with 1- to 3-mm margins if transected on biopsy. (6) Re-excision is not necessary if the AST does not extend to the biopsy margin(s) when complete/excisional biopsy was performed. (7) SLNB should not be performed for Spitz tumors unless a diagnosis of CM is favored on clinicopathologic evaluation. (8) Non-Spitz melanocytomas have a presumed increased risk for progression to CM and should be excised with 1- to 3-mm margins if transected on biopsy. (9) Re-excision of non-Spitz melanocytomas is not necessary if the lesion is completely excised on biopsy.

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小儿皮肤黑色素瘤以及非典型斯皮茨和非斯皮茨黑色素细胞瘤(黑色素细胞瘤)的评估和手术治疗:儿童肿瘤学小组报告。
目的:本研究旨在为儿科(0-10 岁)和青少年(11-18 岁)患者的皮肤黑色素瘤(CM)、非典型斯皮茨瘤(AST)和非斯皮茨黑素细胞瘤(黑素细胞瘤)的诊断评估和手术治疗提出建议:方法:由儿童肿瘤组织牵头,召集外部多学科 CM 专家组成专家小组,在现有数据和专业知识的基础上提出建议:结果:来自多个专业(皮肤/内科/外科肿瘤学、皮肤病学和皮肤病理学)的 33 位专家根据 87 篇同行评审出版物中的支持性数据制定了建议。(2)在缺乏儿科手术试验和/或队列研究数据的情况下,CM的最终手术治疗,包括广泛局部切除和前哨淋巴结活检(SLNB),应遵循美国国家综合癌症网络指南。(3)免疫组化和新一代测序技术更有可能将 AST 准确分类为良性或恶性。(4)临床病理和/或分子相关性研究可能无法将某些 AST 划分为可能/明确的良性或恶性,这些恶性潜能不确定的 Spitz 肿瘤应以 5 mm 的边缘切除。(5)如果活检时横断的 AST 被认为是良性的,应切除 1 至 3 毫米的边缘。(6) 如果在进行完整/切除活检时,AST 未延伸至活检边缘,则无需再次切除。(7) 除非临床病理评估倾向于诊断为 CM,否则不应对 Spitz 肿瘤进行 SLNB。(8)非Spitz黑色素细胞瘤进展为CM的风险推测较高,如果活检时横切,应切除1至3毫米的边缘。(9)如果活检时病灶已完全切除,则无需再次切除非Spitz黑色素细胞瘤。
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来源期刊
Journal of Clinical Oncology
Journal of Clinical Oncology 医学-肿瘤学
CiteScore
41.20
自引率
2.20%
发文量
8215
审稿时长
2 months
期刊介绍: The Journal of Clinical Oncology serves its readers as the single most credible, authoritative resource for disseminating significant clinical oncology research. In print and in electronic format, JCO strives to publish the highest quality articles dedicated to clinical research. Original Reports remain the focus of JCO, but this scientific communication is enhanced by appropriately selected Editorials, Commentaries, Reviews, and other work that relate to the care of patients with cancer.
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