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Journal of the American Academy of Dermatology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le mardi 28 janvier 2020
Doi : 10.1016/j.jaad.2019.10.065
accepted : 25 October 2019
The prognostic value of tumor mitotic rate in children and adolescents with cutaneous melanoma: A retrospective cohort study

Norbertus A. Ipenburg, MD a, Serigne N. Lo, PhD a, Ricardo E. Vilain, MBBS, PhD a, Lodewijka H.J. Holtkamp, MD a, b, James S. Wilmott, PhD a, c, Omgo E. Nieweg, MD, PhD a, c, d, John F. Thompson, MD a, c, d, Richard A. Scolyer, MD a, c, e,
a Melanoma Institute Australia, Sydney, New South Wales, Australia 
b Department of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands 
c Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia 
d Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia 
e Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia 

Reprint requests: Richard A. Scolyer, MD, Melanoma Institute Australia, 40 Rocklands Road, North Sydney, NSW 2065, Australia.Melanoma Institute Australia40 Rocklands RoadNorth SydneyNSW2065Australia

Mitotic rate is a strong predictor of outcome in adult patients with primary cutaneous melanoma, but for children and adolescent patients this is unknown.


We sought to assess the prognostic value of primary tumor mitotic rate in children and adolescents with primary melanoma.


This was a cohort study of 156 patients who were <20 years of age and who had clinically localized cutaneous melanoma. Patients <12 years of age were classified as children and those 12 to 19 years of age as adolescents. Clinicopathologic and outcome data were collected. Recurrence-free and melanoma-specific survival were calculated. Univariable and multivariable analyses were performed using Cox proportional hazard models.


Thirteen of 156 patients (8%) were children. The mitotic rate was ≥1/mm2 in 104 patients (67%) and correlated with increasing Breslow thickness. A positive sentinel node was found in 23 of 61 patients (38%) in whom a sentinel lymph node biopsy specimen was obtained. The median follow-up was 61 months. Five-year melanoma-specific and recurrence-free survival rates were 91% and 84%, respectively. Mitotic rate was a stronger predictor of outcome than tumor thickness and was the only factor independently associated with recurrence-free survival.


This research was conducted at a single institution and the sample size was small.


Mitotic rate is an independent predictor of recurrence-free survival in children and adolescents with clinically localized melanoma.

The full text of this article is available in PDF format.

Key words : adolescent, children, dermatopathology, melanoma, mitosis, mitotic rate, oncology, pathology, pediatric, prognosis, recurrence

Abbreviations used : CI, HR, MIA, MSS, RFS, SN, SNB

 Funding sources: None.
 Dr Ipenburg had travel, accommodation, and meeting expenses paid by Janssen-Cilag and Novartis. Dr Thompson received honoraria for advisory board membership from GlaxoSmithKline, Merck Sharp Dohme, Bristol Myers Squibb, and Provectus. Dr Scolyer received professional services fees from Merck Sharp Dohme, Novartis, Myriad, and NeraCare. Drs Nieweg, Holtkamp, Lo, Vilain, and Wilmott have no conflicts of interest to disclose.
 This study was approved by the Melanoma Institute Australia Research Committee and the Sydney Local Health District Ethics Review Committee (Protocol No. X15-0454 and HREC/11/RPAH/444).

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