Melanoma em Idade Pediátrica: Epidemiologia, Patogénese, Diagnóstico e Tratamento
Resumo
O melanoma é o cancro cutâneo mais comum da idade pediátrica. No entanto, é extremamente raro nesta população, sendo ainda mais raro nas crianças com menos de 11 anos. O diagnóstico é frequentemente difícil, devido à sua raridade e apresentações atípicas. Existem três subtipos de melanoma em idade pediátrica: melanoma Spitzoide; melanoma que emerge de nevo melanocítico congénito e o melanoma convencional. O melanoma congénito pode ocorrer, embora seja excepcionalmente raro, não constituindo um subtipo distinto de melanoma. O melanoma Spitzoide é o subtipo mais comum que afecta crianças com idade inferior a 11 anos. Embora apresente características locais agressivas, com envolvimento ganglionar frequente, acarreta um prognóstico excelente. A ocorrência de transformação maligna de nevos melanocíticos congénitos apresenta uma grande variabilidade, de acordo com a sua dimensão, número e afeção concomitante do sistema nervoso central. A vigilância e tratamento desta transformação maligna é problemática, sendo associada a pobres resultados. Nos adolescentes, o subtipo de melanoma mais comum é o convencional (tipo adulto). Contrariamente à população adulta, a maioria dos melanomas pediátricos convencionais tem origem em nevos pré-existentes, seguindo a epidemiologia e factores de risco associados ao do adulto. Não existem orientações específicas para a gestão e tratamento do melanoma pediátrico, pelo que esta doença é tratada de forma semelhante ao melanoma do adulto.
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