Dr. Riccardo Pampena
Skin Cancer Unit of the Arcispedale Santa Maria Nuova of Reggio Emilia, Italia
Pediatric melanoma: a systematic review and individual patient meta-analysis
Autor: Riccardo Pampena
Purpose: To systematically review the evidence on pediatric melanoma, highlighting the major sources of heterogeneity and focusing on available data on single patients.
Patients and Methods: We systematically searched the PubMed, Embase and Cochrane Central databases from inception (then restricted to 1948) to January 25th 2021, for studies reporting at least one case of cutaneous melanoma in patients ≤18 years. The age cut-off was defined after the primary search, based on literature results. Transplacental, unknown primary and uncertain malignant melanomas were excluded.
A patient-level meta-analysis was performed considering as outcomes the melanoma-specific (MSS) and progression-free survival (PFS). Separate analysis were done for cases with complete information on histologic subtype, focusing on superficial spreading (SSM), nodular (NM) and spitzoid melanomas, and nevus-association status, classified as de-novo, acquired- or congenital-nevus associated melanoma (NAM).
Kaplan-Meier and Cox regression analysis were performed, alpha level was set at 0.01 to reduce Type I error.
Results: Two-hundred-sixty-six studies were included in the qualitative synthesis, however data on single patients were available for 213 studies including 1002 patients. Concerning histologic subtypes, NM had lower MSS than both SSM and spitzoid melanoma, but only lower PFS than SSM. Spitzoid melanoma had significant higher progression risk than SSM, and a trend towards lower mortality. Focusing on nevus-association status, de-novo melanoma demonstrated higher MSS after progression than congenital-NAM, while no differences were highlighted in PFS.
Conclusion: Our findings depict the existence of different biological patterns of pediatric melanoma. In particular, spitzoid melanoma demonstrated an intermediate behavior between SSM and NM, showing high risk of nodal progression but low mortality. This raises the question on possible overdiagnosis of spitzoid lesions as melanoma in childhood.
Dr. Riccardo Pampena is a board-certified Dermatologist specialized in the diagnosis and treatment of skin cancers.
He obtained his degree in Surgery and Medicine (MD) from the Medicine University of the Sacred Heart of Rome in 2011 with full mark; then, he trained and became a board Certified Dermatologist (full mark) of the Department of Dermatology and Venereology of the Sapienza University of Rome, in 2016 defending a thesis on the role of Dermoscopy in predicting the efficacy of ingenol mebutate therapy for actinic keratosis.
Since 2011 he practices research mainly in the field of psoriasis and non-invasive diagnosis in dermato-oncology, paying particular attention to the study of melanoma and pigmented skin lesions by means of non-invasive methods, such as dermoscopy and confocal microscopy for the in vivo and ex vivo study of cytological and architectural aspects of pigmented skin lesions, in correlation with histopathology.
Since November 2016, Dr. Pampena has been working at the Skin Cancer Unit of the Arcispedale Santa Maria Nuova of Reggio Emilia, which is a third-level referral center for skin tumors diagnosis and management and recently became a Board Member of the International Dermoscopy Society. The collaboration of Dr. Pampena with the Skin Cancer Unit of Reggio Emilia started in January 2015 with a 2-month fellowship performed during his residency in Dermatology and Venereology.
Furthermore, he’s actively involved, as a researcher and statistician, in scientific studies. He also attended specific courses in Biostatistics and Cochrane Systematic Reviews and Meta-analysis.