Melanoma (Skin Cancer)

Melanoma is a highly malignant skin cancer that begins in melanocytes — cells that make melanin — 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.

Among children and teenagers, melanoma often looks different and may grow faster than it does in adults — sun exposure also plays less of a role in the development of the disease in children. Pediatric melanoma has increased on average 2 percent-per-year since 1973, although its frequency seems to have decreased over the last few years. Children with fair skin, freckles, and blonde or red hair are at higher risk of developing melanoma than other 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:

• Bump on the skin that itches or bleeds
• Wart-like spot that is typically yellowish, whitish, or pink
• Lesion on the skin, which may not be black or darkly pigmented as in adults
• Odd-looking 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
• Family history of unusual moles
• Family history of melanoma

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

• Fair skin
• History of many blistering sunburns
• Several large or many small moles
• Family history of unusual moles
• Family history of melanoma

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:

• 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

In children and teens, color may be lighter instead of darker.

Children at higher 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 symptoms of melanoma in children.

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

• Surgery
• Chemotherapy
• Radiation therapy
• Immunotherapy

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.

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.

Children with melanoma are treated at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center 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.

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.

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.