A Multi-Institutional Central Pathology and Molecular Risk-Based Stratification Study of Surgical Management for Melanoma, Atypical Spitz/Spitzoid Tumors, and Other Atypical Melanocytic Neoplasms in Pediatric Patients

Summary

This phase II trial compares the effect of using risk-based stratification to guide surgical management to the usual approach in treating cutaneous melanoma, atypical Spitz/Spitzoid tumors or other atypical melanocytic tumors that have not spread to other parts of the body (localized). Melanoma is a cancer that in children is sometimes difficult to tell apart from benign (not harmful) or atypical (uncertain if harmful) skin lesions. Failure to diagnose melanoma can result in inadequate surgical removal and increase the risk of recurrence and metastatic disease (spread from where it first started to other places in the body). In addition, diagnosing a tumor a benign (not cancer) tumor as cancer may lead to unnecessary surgery and treatment. This trial reviews tumor pathology and genetic markers and classifies the tumor as not atypical, atypical but low risk for spread and/or recurrence (coming back after a period of improvement), and atypical and high risk for spread and/or recurrence. The classifications are then used to provide surgical recommendations. Tumors that are not atypical do not receive any surgical treatment. Low-risk recommendations include removing a small layer of normal skin around the tumor. High-risk recommendations include the usual adult melanoma approach of removing a larger layer of normal skin around the tumor with or without a biopsy of the sentinel lymph node (the first lymph node to which tumor cells are likely to spread from a primary tumor). Risk-based guided surgical management may help avoid unnecessary surgery while improving outcomes in younger patients with localized cutaneous melanoma, atypical Spitz/Spitzoid tumors or other atypical melanocytic tumors.

Description

Eligibility

Age range

Up to 25 years

Sex

All

Healthy volunteers

No

Interventions

• Procedure
  Biospecimen Collection

  Undergo blood sample collection

• Procedure
  Chest Radiography

  Undergo chest x-ray

• Procedure
  Computed Tomography

  Undergo CT or FDG PET/CT

• Other
  Fludeoxyglucose F-18

  Given FDG

• Procedure
  Magnetic Resonance Imaging

  Undergo MRI, PET/MRI or brain MRI

• Other
  Patient Observation

  Undergo observation

• Procedure
  Positron Emission Tomography

  Undergo whole body FDG PET/CT or PET/MRI

• Procedure
  Re-Excision

  Undergo narrow margin re-excision

• Procedure
  Sentinel Lymph Node Biopsy

  Undergo SLNB

• Procedure
  Ultrasound Imaging

  Undergo nodal basin ultrasound

• Procedure
  Wide Local Excision

  Undergo wide local excision

Locations (13)