Treatment outcomes in pediatric melanoma—Are there benefits to specialized care?

Purpose The purpose of this study was to evaluate the impact of hospital specialization on survival in pediatric melanoma. Methods We reviewed all patients under 18 years old with cutaneous melanoma evaluated at MD Anderson Cancer Center, a National Cancer Institute (NCI)-designated center, from 2000 to 2014. We compared overall survival (OS) and disease-free survival (DFS) between patients who underwent all treatments at MDACC (Group A, n = 146) and those who underwent initial surgical treatment at a non-NCI center (Group B, n = 58). Kaplan–Meier survival curves were compared using the log-rank test. Results Group A patients had significantly better OS and DFS (both p < 0.001). Five-year OS was 97% (95% CI 92%–99%) in Group A versus 88% (95% CI 74%–94%) in Group B. Group survival differences were most notable in Stage 3 and 4 patients. Group A patients presenting with stage III or IV disease had a 5-year OS rate of 91.2% (95% CI 75.1%–97.1%) compared to 80.8% (95% CI 59.8%–91.5%) in Group B. The DFS rate was 94.4% (95% CI 88.5%–97.3%) in Group A versus 77.2% (95% CI 62.5%–86.7%) in Group B. Conclusion Surgical treatment at a comprehensive cancer center may improve outcomes for pediatric melanoma especially for patients presenting with later stage disease. Level of evidence Case-control study: Level III.