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Complications In the Surgical Treatment of Pediatric Melanoma

Saturday, October 20, 2012: 1:12 PM
Napoleon Ballroom (Hilton Riverside)
Paul E. Palmer III, B.S.1, Carla L. Warneke, MS2, Andrea A. Hayes-Jordan, MD3, Kevin P. Lally, MD, MS1, Cynthia E. Herzog, MD4, Dennis P. Hughes, MD, PhD4 and Mary T. Austin, MD, MPH3, (1)Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX, (2)Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, (3)Surgical Oncology and Pediatrics, Children's Cancer Hospital, The University of Texas MD Anderson Cancer Center, Houston, TX, (4)Pediatrics, Children's Cancer Hospital, The University of Texas MD Anderson Cancer Center, Houston, TX

Purpose: Pediatric melanoma is found in 300-400 children in the US annually. Due to the rarity of the disease, limited literature has been published and no studies have described the surgical complications that occur in children with melanoma. Our objective was to characterize the complications associated with the surgical treatment of pediatric melanoma.

Methods: The records of all children with melanoma (ages <18 years) treated with surgical intervention at the Children’s Cancer Hospital at the University of Texas MD Anderson Cancer Center from 1992 through 2010 were reviewed. We compared complication rates between three groups: wide local excision only (WLE), WLE and sentinel lymph node biopsy (SLNB), and WLE and completion lymph node dissection (CLND). Additionally, we examined nodal dissection complication rates for the axillary, inguinal, and cervical sites. Complications examined included lymphedema, wound infection, skin graft failures and other wound-related complications. Groups were compared using a two-tailed Fisher’s Exact Probability Test.

Results: We identified 125 patients (52% male) with a median age of 13.8 years (range 1.9 to 17.9 years). Ethnicity was 87% Caucasian, 8% Hispanic and 5% other. Median Breslow depth in all patients was 1.3mm (range 0 to 12mm). Thirty-seven patients received WLE only, 47 received WLE + SLNB, and 41 patients had WLE + CLND. Of the patients receiving SLNB or CLND (n=88), procedure location was 47% axillary, 29% inguinal, and 24% cervical. There was a significant difference in the incidence of surgical complications between the treatment groups: WLE 19%, SLNB 11% and CLND 39% (p=0.006). The risk of complications was significantly lower among those receiving WLE + SLNB versus those receiving WLE + CLND (OR 0.19, 95% CI 0.06 – 0.57, p = 0.0032). Lymphedema, the most common complication in nodal dissections, had a significantly higher incidence in the CLND group compared to the SLNB group (19.5% vs. 2.1%, p=0.01). Inguinal dissections were more likely to have complications compared to axillary dissection (52% vs. 17.1%) and neck dissections (52% vs. 0%) (p < 0.0001). There were no surgical complications identified in either SLNB or CLND of the cervical region.

Conclusion: There is a significant difference in the risk of developing complications depending on the type of surgical intervention performed in pediatric melanoma.  Lymphedema was the most prevalent complication and was most often observed in patients undergoing CLND. There was an overall increased risk of complication associated with inguinal lymph node dissection compared to axillary lymph node dissection.