Historical Perspective: Fisher et al., 1988

 
In 1988, Fisher and colleagues41 communicated their findings in 17 patients 20 years of age and younger who had a primary melanoma on the head or neck. Among them were melanomas that appeared on an iris of two patients. The series derived from 4,843 patients with melanoma registered at the Duke University Melanoma Clinic from 1972 through 1986. A computer-aided analysis was performed of age at diagnosis, sex, type of melanoma, Clark level, Breslow depth, "histogenetic" classification, site of primary neoplasm, status of lymph nodes at the time of diagnosis, surgical treatment, rate of recurrence, site of recurrence, and status at follow-up. No effort was made to stratify according to age and no photomicrographs were shown. This is what Fisher and coworkers said in regard to anatomic site vis-à-vis prognosis of melanoma in young persons:
 
"When juvenile patients with melanomas of the head and neck are compared to a comparable age group of patients with melanomas at other primary body sites, the head and neck group had a significantly higher frequency of death. Compared to the adult head and neck population, juvenile patients had identical actuarial survivial time, but shorter disease-free intervals, even though the adult population had a higher percent of poor prognostic indicies (presence of ulceration and thickness of lesions). Failure to control local and regional disease coupled with the overall poor survivial rate, indicates that malignant melanoma occurs in the young as a biologically active tumor and suggests an aggressive local and regional disease and, hopefully, survival."