Treatment for paediatric melanoma
Each case should be approached individually taking into consideration: age of the patient, size and location of the lesion, stage of melanoma, psychological impact, surgical procedures, psychological and / or clinical interventions.11 Treatment may include clinical follow-up, with special attention to changes in colour, texture or on the surface of the lesion.
Surgery is the first-line therapy for paediatric melanoma when diagnosed early (refer to excisional biopsy in How is melanoma diagnosed?). The margin size depends on the thickness of melanoma. Margins of excision specific to paediatric melanoma patients have not been defined. While in most cases adult guidelines are followed, in younger children consideration should be given to narrower margins of excision than those used in adults. Thin (<1 mm) paediatric melanomas typically do not require further treatment beyond wide excision, though the children will enter a monitoring phase with regular skin and lymph node examinations.
The use of chemotherapy and radiation therapy is not effective in modifying the course of the disease. Therefore, patients and / or their parents should be instructed to perform regular self-examination of skin and anticipate the medical consultation in case there are changes of colour, shape, surface or appearance of the nevus or also other abnormal symptoms. Studies show that children who are treated for melanoma are at increased risk for disease recurrence later in life.
Finally, research is being developed to identify targets for immunotherapy that could be directed to genes of interest. These therapies are being investigated and further clinical trials could be developed. Refer to section Research for further details.