Pediatric Melanoma
What you should know before taking your child out in the sun.
by Allison Vidimos, R.Ph., M.D.

PARENTGUIDE News July 2007

Skin cancer will affect more than one million individuals in the United States in 2007. Although adults are most commonly affected by the disease, about 300 potentially deadly skin cancer cases are diagnosed among children each year.

Unfortunately, because most parents and many physicians do not expect to find skin cancer on children, this disease is often overlooked or diagnosed at a later stage, many times putting children at greater risk of a poor outcome. The most dangerous form of skin cancer, called melanoma, is responsible for one to three percent of all childhood malignancies, and this number has been rising steadily.

Since pediatric melanoma tends to be deeper at diagnosis in comparison to adult melanomas, it is crucial for parents and physicians to be aware that this potentially deadly skin cancer can occur in children. In addition to the delay in diagnosis frequently associated with children, another challenge is the correct pathological diagnosis. Fifty percent of childhood melanomas arise on normal-appearing skin. The remaining 50 percent arise in a pre-existing lesion such as a mole or birthmark, with more than half of those skin cancers appearing before puberty (age 14). Larger (giant) moles or birthmarks that appear on the back of the body in the midline have the greatest risk for becoming malignant and should be carefully examined and, if necessary, biopsied by a dermatologist.

Some children are at greater risk for skin cancer than others and should be monitored more closely by their parents and a dermatologist to ensure that any skin cancer is found at an early, treatable stage. Children are at greater risk if there is a family history of melanoma, if they are fair skinned or have a tendency to freckle, if they have several moles (greater than 50), or if they have a giant birthmark (mole). Other risk factors include a history of blistering sunburns, excessive sun exposure or use of tanning beds. Children with impaired immune systems, such as other forms of disease or organ transplant patients, are also at a higher risk of acquiring skin cancer. And, a child that has undergone any type of chemotherapy may see an increase in the number of moles on his body, placing him in further danger.

Due to the rarity of pediatric melanoma, there is a lack of information and studies to guide physicians on how to care for children with skin cancer. More research needs to be conducted on pediatric skin cancer to improve diagnosis and treatment. Currently, physicians treat children the same way they treat adult patients and base treatments on the extent of the cancer. Surgical excision of giant moles (greater than 20 centimeters or 8 inches in diameter) is advocated when cosmetically and functionally possible. The best defenses against melanoma in children are education of parents, teachers and physicians; sun avoidance and protection; and close follow up of high-risk patients with suspicious moles, which should be promptly biopsied.

Parents should be on the lookout for certain signs that indicate potential skin cancer in a child. Those signs include:
•a sudden increase in the size of a mole or birthmark.
•bleeding or itching of a skin growth.
•change of color of a mole or birthmark.

An easy way for parents to remember what to look for when it comes to skin cancer is to follow the alphabet. The ABCDE’s of melanoma should alert a parent and a physician to the possible diagnosis of melanoma: Asymmetry, Borders that are irregular, Color variation within a mole, Diameter greater than 6 millimeters, and Elevation— a mole or mark that becomes raised or bumpy.

Parents can also use the following sun safety tips to further help protect their children from skin cancer.
•Apply sunscreen 30 minutes prior to sun exposure and use at least SPF 15.
•Apply enough sunscreen. Two tablespoons are required to adequately cover an adult’s body.
•Reapply sunscreen every two hours when outdoors, even on cloudy days.
•Dress children in protective, tightly woven clothing and hats, and have them wear sunglasses.
•Keep children in the shade when possible, especially during the strongest sun hours between 11am and 3pm.
•Protect children by minimizing sun exposure and applying sunscreen multiple times throughout the day.

Allison Vidimos, R.Ph., M.D., is a member of the American Society for Dermatologic Surgery and chairman of the Department of Dermatology at the Cleveland Clinic.