Evaluation of Paediatric Melanoma Management in a UK Major Tertiary Centre: A Twenty-Year Review

Objectives: This study evaluates the management of paediatric melanoma at a tertiary centre, comparing clinical practices with international guidelines from the European Cooperative Study Group for Pediatric Rare Tumors (EXPeRT) and the National Comprehensive Cancer Network (NCCN) to highlight real-world practices and make recommendations for future research priorities. The differences between conventional and Spitzoid melanomas were also explored in a subgroup analysis. Background: Paediatric melanoma is rare and is most commonly caused by UV exposure or familial mutations. Management of paediatric melanoma is challenging due to diagnostic, histological and treatment complexities, coupled with limited paediatric-specific evidence. Treatment typically involves wide local excision (WLE) for localised melanoma. Advanced cases may require systemic therapy, such as chemotherapy or immunotherapy; however, paediatric-specific clinical trials to support treatment protocols are limited, and therefore, treatment is initiated on a case-by-case basis. Methods: A retrospective case series analysis was completed for all melanoma patients aged between 0 and 15 years presenting at Birmingham Children's Hospital, a UK tertiary paediatric centre, between 2003 and 2023. Statistical analysis was performed using the t-test for continuous variables and Fisher's exact test for categorical data. Results: Eight cases were treated, with an average diagnosis age of 9.8 years. Tumours were most often located on the extremities (4/8, 50%), followed by the head and neck (2/8, 25%). All cases underwent WLE, and three (3/8, 38%) were considered for sentinel lymph node biopsy (SLNB). There was 100% (8/8) compliance with discussion in a specialist melanoma multidisciplinary team (MDT) and review by experienced dermatopathologists. Follow-up imaging and compliance with guidelines were inconsistent, with only two (2/8, 25%) receiving recommended imaging. Conclusions: Findings show excellent compliance with key recommendations that all cases should be discussed in a specialist melanoma MDT and histology reviewed by an experienced dermatopathologist. There was variability in biopsy techniques, imaging, and follow-up, suggesting a need for standardised guidelines to guide best practice. Future research should include multicentre, randomised, blinded paediatric-specific clinical trials to compare outcomes to potential treatments.