• Melanoma in Children and Teens

    Melanoma is a highly malignant skin cancer that begins in melanocytes (cells that make the pigment melanin, which gives our skin its color) of normal skin or moles and spreads rapidly and widely. It primarily occurs in adults, but about 300 children in the U.S. are diagnosed with melanoma each year. While melanoma is the least common type of skin cancer in adults, skin cancer in children is almost always melanoma.

    Pediatric melanoma has increased on average 2% per year since 1973, although its incidence seems to have decreased over the last few years. The biggest increase in recent decades has been in girls ages 15-19, possibly because girls are more likely than boys to sunbathe and use tanning beds.

    Among children and teenagers, melanoma often looks different and may grow faster than it does in adults. Also, sun exposure plays less of a role in the development of the disease in children. Kids with fair skin, freckles, and blonde or red hair are at higher risk of developing melanoma than other children.

    Pediatric Melanoma Treatment at Dana-Farber/Boston Children’s

    Children with melanoma are treated at Dana-Farber/Boston Children’s through our Rare Tumors Program. Our treatment teams have expertise in treating many rare forms of cancer, and many of our specialists are also active researchers, providing your child access to the most advanced treatments available.

    What are the melanoma symptoms and risk factors in children?

    While melanomas in adults tend to turn darker, in children they often are whitish, yellowish, or pink. The most common symptoms of melanoma include:

    • A bump on the skin that itches or bleeds
    • A wart-like spot that is typically yellowish, whitish, or pink
    • A lesion on the skin, which may not be black or darkly pigmented as in adults
    • Odd-looking moles, especially larger ones
    • Moles that look different than a child’s other moles

    As with adults, children are most at risk for melanoma if they have:

    • Fair skin
    • A history of many blistering sunburns
    • Several large or many small moles
    • A family history of unusual moles
    • A family history of melanoma

    How is childhood melanoma diagnosed?

    Become familiar with your child's skin and the pattern of moles, freckles, and other marks on his or her body. Be alert to changes in the number, size, shape, and color of pigmented areas, as this can be a sign of melanoma.

    The same “ABCDE rule” used to determine whether a doctor should check a mole in adults also applies to children and teenagers. Just remember that in children and teens, color may be lighter instead of darker.

    • A for asymmetry: One half is differently shaped than the other
    • B for border irregularity: Jagged or blurred edges
    • C for color: The pigmentation is not consistent; color could be light or dark
    • D for diameter: Moles greater than six millimeters (the size of a pencil eraser)
    • E for evolving: A mole changing in size, shape, or color

    Children at high risk should be seen by a pediatric dermatologist annually. Also, remember that melanoma can occur in places not exposed to the sun, so make sure your child’s scalp, feet, hands, and buttocks are also checked.

    In addition to a complete medical history and physical examination, melanoma is diagnosed with a biopsy of the lesion. It is important to have your child’s biopsy reviewed by a pediatric team. Dermatologists and pathologists used to seeing adult melanomas may not notice key signs of melanoma in children.

    What is the treatment for melanoma in children?

    Low-stage melanoma is treated primarily with observation. Other common treatments include:

    • Surgery — to remove the entire melanoma and any cancerous lymph nodes to which the disease has spread. Some melanomas can be removed easily and require only minor surgery, while others may require a more extensive surgical procedure.
    • Chemotherapy — may be used if the disease has spread to the lymph nodes or to other organs
    • Radiation therapy — another option to treat disease that has spread to the lymph nodes
    • Immunotherapy — the introduction of molecules to your child’s system that can train his or her immune system to attack the cancer cells

    Although treatment options for children are similar to those used for adults, a pediatric center will know how to best tailor treatment to the needs of children – and specialized programs like the Dana-Farber/Boston Children’s Rare Tumors Program have unique expertise and access to treatment options that might not be available at other centers.

    What is the latest research on melanoma in children?

    Precision Medicine and Immunotherapy for Melanoma

    Dana-Farber/Boston Children’s is at the forefront of new research and clinical trials investigating the use of precision medicine and immunotherapy to treat childhood and adolescent melanoma. Precision medicine tailors treatment to the specific genetic characteristics of the patient’s cancer – for example, selecting drugs matched to the tumor profile. Immunotherapy for melanoma works by unleashing a very brisk and sustained response of the immune system against melanoma cells.

    See our clinical trials for melanoma available at Dana-Farber/Boston Children’s. If you have questions or need advice on whether a particular trial would be appropriate for your child, email our clinical trials team at clinicaltrials@danafarberbostonchildrens.org. We can help you navigate your options.

    What is the long-term outlook for children with melanoma?

    Children with melanoma typically fare better than adults. The overall five-year survival rate for children and adolescents with melanoma is 90 percent. About 60 percent of children whose disease has spread to the lymph nodes are expected to survive long-term.

    A significant number of recurrences and melanoma-related deaths have been reported, so frequent medical checkups are important as children become adults. Studies show that children who are treated for melanoma are at increased risk for disease recurrence later in life.

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