Pediatric cancer and cutaneous complications highlighted in new session

A new session Friday designated a topic in dermatology with capital letters in “The Big C’s: Children, Cancer, and Cutaneous Complications.” The session covered the diagnosis and management of primary cutaneous malignancies and the cutaneous effects of oncologic therapy in children. Six speakers discussed several topics, including melanoma, congenital nevi, lymphoproliferative disorders, cutaneous T-cell lymphoma, graft-versus-host disease, and the cutaneous effects of common chemotherapeutic agents.

In an earlier interview, session director Jennifer T. Huang, MD, instructor in dermatology at Boston Children’s Hospital, spoke of the impetus for introducing the session to the annual meeting.

“Some of these conditions are so rare in children, particularly skin tumors, so it’s very hard to study them within one institution. We really need a collaboration of multiple institutions to have enough data to make conclusions,” Dr. Huang said.

To that end, Dr. Huang gathered a group of pediatric dermatologists to present their experiences and expertise with these conditions. The question of when to watch and wait and when to take action were discussed with each topic.

Elena B. Hawryluk, MD, PhD, from Massachusetts General Hospital for Children, presented “Congenital Nevi and Pediatric Melanoma.” She reviewed the data on managing congenital nevi and the risk for transformation into melanoma, including the myths and truths about congenital nevi.

“In the past we’ve been trained to remove many congenital nevi due to the potential risks for melanoma,” said Dr. Huang, “but over time we’ve found that the risk for transformation into melanoma at least for the small and medium-sized congenital nevi is quite small, and most can be followed rather than surgically removed. The ones to watch for are the giant congenital nevi with satellite lesions.”

Markus Boos, MD, PhD, from the Children’s Hospital of Pennsylvania, discussed “Lymphoproliferative Disorders and CTCL in Children.” He spoke about the diagnosis, management, and various presentations of pityriasis lichenoides and when to worry about this papulosquamous disorder changing to a cutaneous T cell lymphoma.

In “CPC: Malignancy or Not?” Sheilagh M. Maguiness, MD, and Daniel D. Miller, MD, both from the University of Minnesota Medical School, Minneapolis, presented case studies of malignant skin disease in children and their benign mimickers.

Ellen K. Roh, MD, from Massachusetts General Hospital for Children, spoke on “Cutaneous Reactions to Common Chemotherapeutic Agents in Children,” including recognizing and managing drug rashes. “The important thing about this topic is when it is important to stop the medication and when is it OK to continue it and just manage the rash,” said Dr. Huang.

In the final presentation, Dr. Huang discussed “Cutaneous complications from bone marrow transplantation in children.” Complications range from graft versus host disease of the skin to delayed effects of the transplant, such as skin cancer.

Dr. Huang said she hoped the session would spark interest and collaboration in “the big C’s.” “It’s an area that needs a lot of research and so hopefully the session will garner some interest in people who might be interested in collaborating and answering some of these questions,” she said.

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