What is Pediatric Melanoma?
Pediatric melanoma incidence had been increasing by approximately 1.7% per year from 1975 until 1994 when it began decreasing. The biggest increase in recent decades has been in girls ages 15-19, which may be attributable to girls sunbathing and using tanning beds more frequently than boys. Approximately 400 cases of melanoma are diagnosed each year in patients younger than 20 years old in the United States.
Pediatric melanoma can be divided into three main categories: conventional melanoma, melanoma arising in a congenital melanocytic nevus, and spitzoid melanoma. Differentiating between these subtypes is important because each type has different treatment options, risk factors, and histological findings.
Pediatric Melanoma Risk Factors
Although the cause of melanoma in children is not known, certain attributes, characteristics, and exposures make it more likely that a child will develop this type of cancer. These risk factors include:
- Giant melanocytic nevi
- Prolonged exposure to sunlight, though less of a factor in children than adults.
- Red or blond hair, blue eyes, freckles
- A tendency to sunburn and not tan
- A large number of moles
- A family history of melanoma
- Immunosuppression, immunodeficiency
- History of retinoblastoma
- Certain inherited disorders including xeroderma pigmentosum and Werner Syndrome
Not everyone with risk factors develops melanoma: however, if your child has risk factors, you should discuss them with a physician.
What are the Symptoms of Melanoma in Children?
Pediatric melanoma usually first appears as a suspicious mole. Symptoms may include:
- Change in shape, color, or size of a mole
- A mole without color or pigmentation
- A mole that is painful or appears as a sore that doesn’t heal
- A mole that itches or bleeds
- A lump that looks shiny or crusty
- A dark spot under a fingernail or toenail not caused by trauma to the nail
Remember that most moles are not melanomas, and the appearance of moles can be a normal occurrence in children up until puberty, as the development process continues.
This presentation is part of AIM at Melanoma’s Living with Melanoma Symposium co-hosted with Moffitt Cancer Center on September 18, 2019, in Tampa, Florida
How Can Melanoma in Children be Prevented?
Because we don’t know what causes pediatric melanoma, it’s not logical to list ways to prevent it. But researchers do believe that early and extensive sun exposure is a risk factor, and of the risk factors listed above, it’s the only one that can be controlled. Therefore, the most important preventive step you can take to protect children is to reduce their direct exposure to UV rays. Every child needs to wear sun protection. The lighter your child’s natural skin color, the more protection it needs. But both dark- and light-skinned kids need protection from UV rays because any tanning or burning causes skin damage and can lead to developing melanoma or other skin cancers. Make sure your kids:
- Avoid sun/seek shade between 10 am and 4 pm when the sun rays are at their strongest
- Wear UV protective clothing and sunglasses. Look for sunglasses that offer 100% UV protection
- Use a broad-spectrum (UVA/UVB) sunscreen—SPF 30 or higher—whenever they are in the sun
- Never use indoor tanning devices
Babies under six months of age should be covered head to toe. Their skin is thinner and unable to protect itself from UV rays. After six months of age, they can use sunscreen, but it’s still safer to keep them clothed and protected rather than rely on sunscreen entirely.
The ABCDEs for Children
Each month you should check your child’s skin for the ABCDEs–but the ABCDEs are modified for children. Look for spots that:
- are Amelanotic (lack color)
- are Bleeding or raised
- have Color uniformity
- are De novo (new)
- are Evolving (changing)
Look for so-called Ugly Ducklings: any mole/spot that looks different (larger, smaller, darker, etc.) from the others on your child’s skin.
Also look for moles, bumps, or wart-like spots on your child’s skin that are pink or yellowish or that itch or bleed.
If you find anything suspicious, contact your healthcare provider. And schedule an annual skin check appointment for your child with a dermatologist.