DISCUSSION
These results point out a dispersion of the adolescent with melanoma cases in several hospitals and across different type of expertise, in fact we noticed that adolescents with melanoma were treated in different type of unit: pediatric and adult oncology, adult general surgery and dermatology.
Our results confirm a previous Italian analysis showing that only one in three children and one in ten adolescents with melanoma were treated within an Italian pediatric oncology center14.
This is of great concern considering the rarity of the disease in these young patients and call for an urgent rethinking of the way these patients are managed and, more important, of how clinical study should be organized.
Close cooperation between pediatric oncologists/surgeons and experts at specialist adult melanoma centers has been recommended.15 In particular, cooperative networking is necessary for clinical studies.16 Two international early-phase trials on new agents (involving vemurafenib and ipilimumab, respectively) were both prematurely closed due to insufficient recruitment of young melanoma patients.17,18
Our data should warn those who want to plan a cooperative study on melanoma in adolescents, to involve both pediatric oncology centers and adult centres or, include adolescents with melanoma in phase I/II clinical trials dedicated to adults considering that most drugs may have similar pharmacokinetics, tolerability profiles, and recommended doses for adolescents relative to adults19. The latter approach has been supported, among the others, by the ACCELERATE project promoted by the European Society for Paediatric Oncology (SIOPE) and the European Innovative Therapies for Children with Cancer (ITCC) Consortium (https://www.accelerate-platform.org/).