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/).