Melanoma (malignant melanoma) is a type of skin cancer where melanocytes grow out of control. Melanocytes are skin cells that produce melanin, a pigment imparting color to one’s hair, skin, and eyes. According to the National Institute of Health (NIH), although rare, melanoma is the third most common skin cancer type in children, commonly affecting teens between 15 and 19 years (1).
Generally, melanoma can develop anywhere on the skin (epidermis), but it can also occur in the eye (2). Medically, melanoma is considered the most dangerous skin cancer type because it can rapidly spread to other body parts, including vital organs (3). Hence, timely detection and prompt treatment of melanoma in children are crucial.
Keep reading while we tell you about the types, signs and symptoms, possible causes, diagnosis, and treatment of melanoma in children.
Type Of Melanoma In Children
Melanoma, also known as cutaneous melanoma, has three different types. If a child has melanoma, it could be any one of the following (2).
- Conventional melanoma (CM): CM, also known as adult-type melanoma, is the melanoma type that has causes and risk factors similar to those for adults.
- Spitzoid melanoma (SM): It’s the most common melanoma type in children, often appearing as a cluster of tissue that the child can feel under the skin. According to experts, this cluster of tissues is usually round, has one color, and is found on the head, hands, or legs.
- Congenital melanocytic nevus (CMN): It’s a melanoma type that arises from a large, pigmented congenital mole (spitz nevus) or birthmark.
Identifying the exact melanoma types is crucial to ensure proper testing and treatment of the disease.
Signs And Symptoms Of Melanoma
Most melanomas don’t cause any specific symptoms in the early stages. However, as the disease progresses, signs and symptoms could appear. The most common sign of pediatric melanoma is the change in color, shape, size, and feel of a mole. So, parents and caregivers should keep an eye on a mole or growth that (2) (4) (5):
- Changes or grows fast
- Has an odd shape or is large
- Feels bumpy to touch and sticks out from the surrounding skin
- Has whitish, yellowish, pink color, or no color
- Has more than one color
- Itches, pains, or forms a scab and bleeds
- Looks like a sore that doesn’t go away
Besides these, the appearance of a dark spot under a toenail/fingernail that’s not caused by an injury or trauma to the nail should also be checked. Do note most moles aren’t melanoma, and their appearance is often common in children until puberty (4).
Causes Of Melanoma In Children
The precise reason why children develop melanoma is unknown. But, certain risk factors are known to raise a child’s chance of developing melanoma (2).
- Family history of melanoma
- Fair skin, light-colored hair, blue eyes, and freckles
- Many small moles or several large moles on the skin
- History of blistering sunburns
- Chronic or frequent exposure to X-rays
- Immunodeficiency or immunosuppression
- History of retinoblastoma (eye cancer type that starts in the retina)
- Certain congenital conditions, such as xeroderma pigmentosum, Werner syndrome, and melanocytic nevi
Diagnosis Of Melanoma In Children
After collecting the child’s medical history and noting their risk factors, a doctor performs the following tests to diagnose melanoma in children (6).
1. Physical examination
In this test, the doctor examines the mole (or any abnormal spot on the skin) using the ABCDE rule developed by dermatologists. The ABCDE rule checks different features of a mole. If one or more of the features show progression, increase, or change, it could be considered a red flag.
A – Asymmetry
B – Border
C – Color
D – Diameter
E – Evolving
Generally, melanoma in children aged 11 years and older looks similar to melanoma in adults. However, doctors follow the ABCDE rule with additional detection criteria in children aged ten years and younger. For instance, melanoma in children usually has one color, which may not be black or brown. Likewise, melanoma tends to be flat in adults, whereas it often appears like a firm, raised bump in children (5).
Once the doctor suspects melanoma, they will take a part of the affected area and look it under the microscope to see if the cells are cancerous. In addition, they will also see how deep the cancer cells are in the skin to determine the risk of melanoma spreading.
Treatment For Melanoma In Children
The treatment for melanoma depends on its stage (stage 0, 1, 2, 3, 4). As the stage progresses, the treatment course varies. Usually, low-stage melanoma is treated with observation. Then, depending on the melanoma stage, other treatment modalities could follow such as those mentioned below (2) (6).
- Surgery: The surgery removes the entire melanoma and some of the normal surrounding tissue. If a nearby lymph node also has cancerous growth, it’s also removed. It’s done to cease the spread of cancerous cells to other areas and body parts. Some melanomas may require more invasive and extensive surgical procedures than others. Since surgery may not be a treatment choice for all children, the doctor may try other treatment methods such as chemotherapy, immunotherapy, or targeted therapy.
- Chemotherapy: This treatment modality may be initiated when cancer has spread to nearby lymph nodes or other organs. A child can be given medications via mouth, injection, or intravenous fluid (IV). The medicine is given to kill cancer cells or prevent their multiplication. In some cases, more than one chemo (combination chemo) may be used. Besides chemo, a child may be given high-energy radiation (radiation therapy) to kill the cancer cells and prevent further spread.
- Immunotherapy: Immunotherapy (biologic therapy) is the treatment method wherein a child is given certain molecules. These molecules sensitize the child’s immune system and train them to detect and destroy cancer cells. This therapy is used for children 12 years and older for whom surgical removal of melanoma isn’t possible.
- Targeted therapy: This treatment method involves using certain medications that directly work on the cells that carry mutated genes that trigger melanoma. For instance, BRAF and MEK inhibitors are medications that target cells with BRAF gene mutation.
Early detection and treatment of melanoma raise a child’s five-year survival by more than 90 percent. The survival rate is 70 percent if the melanoma has spread only to the nearby lymph nodes. However, if melanoma spreads to other blood vessels and body parts, the five-year survival rate is 25 percent.
Possible Complications Of Melanoma Treatment
Here’s a brief list of side effects and complications a child may experience due to different methods of melanoma treatment (7).
- Localized damage to the healthy surrounding skin
- Swelling, reddening, or blistering of the skin around the operated area
- Pain or itching on the operated area
- Scarring or skin color change after skin removal
- Secondary infection at the surgery site
- Bleeding during and after surgery
- Reaction to medication or drug-drug interactions
- Recurrence after treatment, especially at a distant site (metastatic melanoma)
Besides these, if a child’s lymph nodes have been removed, they may develop swelling on the neck, arm, or leg due to fluid retention (lymphoedema).
Prevention Of Melanoma In Children
The precise cause of why melanoma occurs is unknown. Hence, preventing it isn’t possible. However, knowing the risk factors and keeping a close watch on children may help timely detect the disease. Here’s what you can do (8).
- Monitor your child’s skin: Follow the ABCDE rule and look for the shape, size, and color of any mole or spot. If a child has one or more risk factors for melanoma, a dermatologist must examine them annually. Melanoma need not necessarily occur in places exposed to the sun. Therefore, check the skin on body parts not usually exposed to the sun, such as the palms and soles.
- Keep your child away from direct sun : Generally, sun exposure (UV rays) is the main cause of melanoma in adults, but this isn’t the case in children (2). Yet, experts advise children to wear sunscreen before stepping out in the sun. Choose a sunscreen with SPF 30 or higher. Also, avoid chronic exposure in the midday sun between 10 am and 4 pm. Dress your child in protective clothing, such as a hat and shirt with a built-in UV protection shield. Since melanoma can occur in the eye, ensure your child wears sunglasses while in the sun.
Besides these, guide children to avoid tanning beds. According to experts, using tanning beds before 18 years of age raises a child’s risk of developing melanoma by 85 percent (6).
Melanoma is a rare but dangerous cancer type. This disease begins in upper skin layers that can spread to other body parts if not detected and treated on time. Thus, if a child has risk factors for melanoma, a specialist should evaluate their skin annually. In addition, parents should examine their child’s skin regularly and notify the doctor about any changes in moles or the development of new moles.
- Childhood Melanoma Treatment (PDQ®)–Patient Version.
- What Is Skin Cancer?.
- Pediatric Melanoma.
- Melanoma Can Look Different In Children.
- Childhood Melanoma.
- Skin Cancer in Children.
- Protect your kids from skin cancer.