Melanoma in Children: Be Aware of ABCD and Especially E

Symptoms of melanoma may be handily identified alphabetically:

Asymmetry—The shape of one half doesn’t match the other half.
Border—The edges are irregular and often ragged, notched or blurred in outline. The pigment may spread into the surrounding skin.
Color—It is uneven, and shades of black, brown and tan may be present, as well as areas of white, gray, red, pink or blue.
Diameter—A change in size—usually larger—occurs. Although melanomas can be tiny, most are larger than the size of a pea (larger than 6 millimeters or about ¼ inch).
Evolving—The mole changes over a few weeks or months.
National Cancer Institute (NCI) at the National Institutes of Health

When it comes to children and teenagers, however, the “E” is probably the most important symptom to watch for.

“Melanomas in children often grow quickly, so if a pediatrician notices a new or existing mole on a patient that rapidly changes size or shape, it should be removed immediately and sent to pathology for analysis,” says Susan Bayliss, MD, director of pediatric dermatology at St. Louis Children’s Hospital. “Because of their rapid growth, these melanomas can quickly grow deep into the skin. The deeper the lesion, the worse the prognosis because that means the cancer can get into the lymphatic channels.”

She adds, “Physicians also need to be aware that melanomas in children often look different than those in adults. They often can be red and vascular and look similar to a wart.”

Although melanoma in children and teenagers is still considered rare, a 2005 study by researchers at Johns Hopkins University School of Medicine in Baltimore showed that the number of pediatric cases diagnosed each year is increasing. Using statistics from the NCI, the researchers found that between 1973 and 2001 there were 1,255 cases of melanoma in children and teens. The number of melanoma cases increased almost 3 percent every year during that time period, with the biggest increase in children aged 10 to 19. Younger children had just over a 1 percent increase in melanoma diagnoses each year.1

“We know that the younger people are when skin damage occurs from ultraviolet exposure, the higher their risk for developing melanoma. This is especially true for children with red hair and freckles or those with fair complexions who do not tan,” says Dr. Bayliss. “Tanning salons are definitely a factor in the increase we’re seeing of teens and young adults developing melanoma.”

Laws imposing age restrictions for using tanning salons have been legislated by individual states like New York, Wisconsin, Illinois, Texas and Vermont, and countries including Brazil, France, Spain, Portugal, Germany and the United Kingdom. Dr. Bayliss sees this as a positive trend for a behavior she considers as dangerous as smoking.

“Both smoking and indoor tanning are risky behaviors that can have adverse affects on teens’ health in years to come,” she says. “Going to tanning salons can become an addictive behavior, and it is our responsibility as physicians to take as much time educating our patients about the dangers of tanning salons as we do with urging them not to start smoking. Spray tans or tanning lotions are safe alternatives that don’t result in permanent skin damage.”

Another concern regarding melanoma for Dr. Bayliss and Brad Warner, MD, St. Louis Children’s Hospital surgeon-in-chief, is the limited treatment options available for the disease.

“Surgery always is the first treatment for melanoma, and the prognosis for its successful removal is directly related to how thick the cancer is in the skin,” says Dr. Warner. “When melanomas are three-fourths of a millimeter or more deep, there’s a greater chance that the cancer has spread to the lymph nodes or other parts of the body.”

In those cases, patients may need to undergo chemotherapy, radiation therapy, biologic therapy that uses the patient’s immune system to fight the cancer, or targeted therapy using drugs or other substances to identify and attack specific cancer cells without harming normal cells. The success of each treatment is dependent upon the stage at which the melanoma is diagnosed.

“Currently there is no truly effective chemotherapy for treating melanoma, which makes prevention and early detection the best means of stopping this disease,” says Dr. Bayliss.

She notes that children with highly pigmented skin do not necessarily need sunscreen everyday because they have natural protection. But parents of at-risk children should be diligent about applying and reapplying sunscreen, buying lightweight clothes designed to block ultraviolet light, and protecting faces with wide-brimmed hats.

“No one, however, should be going to tanning salons for any reason,” she says. “Even tanning for a short time—for instance, for a prom—can result in skin damage that puts them at needless risk.”

1Strouse JJ, Fears TR, Tucker MA, Wayne AS. Pediatric Melanoma: Risk Factor and Survival Analysis of the Surveillance, Epidemiology and End Results Database; Journal of Clinical Oncology, vol. 23, no. 21, July 20, 2005.

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