AYA melanomas (diagnosed 16-39 years) are rare but rising in incidence. It is not well-understood how they differ from adult melanomas. We aim to describe the demographics, clinic-molecular characteristics and outcomes from our institution.
We retrospectively reviewed all melanoma patients diagnosed between 16 and 39 years old (y) who presented to the National Cancer Centre Singapore from 1 January 2000 to 31 March 2019.
There were 74 patients (41 females, 33 males). 51.4% (n=38) were Chinese, 9.5% Caucasians, 6.8% Malays and the rest of other ethnicity. Across age groups, 9 patients were 16-23 y (12.2%); 26 between 24-31y (35.1%) and 39 between 32-39y (52.7%). The most common subtype was cutaneous melanoma (46%, n=34). 31 (41.9%) patients had BRAF testing. 46.4% (n=13) had BRAF V600E mutation and 1 had BRAF V600K. 20 (27.0%) were tested for cKIT, with none having mutations. 51.4% (n=38) had stage I/II disease (American Joint Committee on Cancer 7th Edition), 16 with stage III and 10 had stage IV. Common metastatic sites were lungs, lymph nodes and liver. 25 (33.8%) patients had sentinel lymph node biopsy (SLNBx), with 5 having lymph node dissection. Among those with SLNBx, 4, 13 and 5 patients had Breslow depths of <1mm, 1-4mm and >4mm respectively. The median depth was 2.7mm (range 0.25–9mm). 7 (9.5%) had first-line systemic therapy, with 5 (2 stage IV; 2 stage III and 1 unknown) receiving immunotherapy. 2 (stage IV) had combination chemotherapy (Dacarbazine/Cisplatin and Paclitaxel/Bevacizumab/Caroboplatin). None received BRAF inhibitors. The median overall survival (OS) is 2.7y (range 0.1–17.7y) for all and 1y for metastatic disease. The 5y OS is 34.5%. The breakdown is shown in the table. Table: 436P
Survival by age and stage
Routine BRAF/cKIT testing commenced in 2010 and immunotherapy started only in 2017, contributing to outcomes we see. Poorer survival is associated with higher stage (p<0.001). Further studies are needed to elucidate potential biological and cancer-specific differences between AYAs and adult melanoma population.
Clinical trial identification
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Has not received any funding.
All authors have declared no conflicts of interest.