Q&A: Childhood Melanoma

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Although melanoma is primarily a disease that occurs among adults, it is also seen occasionally in children, and the number of diagnoses is increasing each year. Children can develop melanoma from excessive sun exposure without proper protection, or it can develop in time after a severe sunburn. Fair-skinned children typically have a higher risk of melanoma, but it is important to know that people of all skin tones can develop the disease. Lauren Mireles in the related story is a case in point.

Dennis Hughes, M.D., Ph.D., assistant professor in MD Anderson's Division of Pediatrics, discusses the differences between adult and pediatric melanoma, as well as some of the risk factors parents should be aware of regarding this disease.

The number of pediatric melanoma cases is on the rise. Why do you think this disease is becoming so prevalent among children?

There are really two reasons. The first is an increasing awareness, on the part of doctors in all specialties, that children can get melanoma. As a result, more skin lesions in children are being evaluated as possible melanomas. In the past, I suspect that there were skin lesions on children that were true melanomas that were removed at doctors' offices and discarded without proper evaluation. Hopefully, that dangerous practice is a thing of the past.

The second reason, I suspect, is that there has probably been a true rise in the incidence of this disease. This may be due to increased sun exposure in children and adolescents compared to some years ago. I hope this is a trend that we will be able to turn around.

Does the disease affect children differently than it does adults?

Pediatric melanoma is so rare that it is very difficult to say how much the behavioral characteristics of this disease differ from the adult disease. As far as we are able to tell, the disease behaves the same way in children as it does in adults. However, there is a clear trend that children fare better than adults at any given stage of disease. One reason could be that children withstand difficult therapies and intensive treatments much better than adults and, therefore, receive more complete therapy when it is needed.

I believe another reason has to do with the nature of the disease itself. Of all of the cancers, melanoma is most susceptible to immunologic approaches to therapy. Indeed, after surgery, immune treatments are the next most likely approach used for this disease. Older children and teenagers have much more robust immune systems than do older adults, and they may combat melanoma on their own better than older patients.

How do treatments for pediatric melanoma patients differ from those for adult melanoma patients?

For the most part, the treatments for pediatric melanoma are similar, stage for stage, to the treatments used in adults. The only real difference is that we have a tendency to use more aggressive treatments in children than we might in adults with the same stage of disease. The reason for this is that pediatric patients are expected to have a much longer life than an adult melanoma patient. Since the average pediatric melanoma patient might be expected to survive another 70 or 80 years, we have an obligation to be very thorough in ensuring that the best possibilities of maintaining a complete remission have been undertaken.

What are some risk factors for pediatric melanoma?

Similar to the situation in adults, children with very light skin, lighter hair and light-colored eyes are at the greatest risk for melanoma. Also, children who have a lot of moles on their skin and children with a family member who has developed melanoma are at increased risk. Severe sunburns in early childhood or during teenage years will predispose children to an increased risk of melanoma later in young adult life.

However, while pale, blond, blue-eyed children are at the highest risk of melanoma, all ethnicities and skin types are potentially at risk. Here at the Children's Cancer Hospital, we have diagnosed melanoma in dark-skinned Hispanic children and in African-Americans. In African-Americans, in particular, there is a tendency toward melanomas presenting at a more advanced stage, perhaps because patients and caregivers erroneously assume that this population cannot develop this disease. The truth is, people of all colors need to be aware of the risk of melanoma and, if there is a spot on the skin that is suspicious, it should be taken seriously and evaluated.

Related story:

Young Patient, Family Experience Shock of Childhood Melanoma
Two years ago, when Lauren Mireles was 11 years old, her parents grew alarmingly concerned over an unusual mole. When they requested a biopsy, the results left them speechless and shocked. Read more about Lauren Mireles.

MD Anderson resources:
Childhood melanoma
MD Anderson Children's Cancer Hospital

Additional resources:
Rare childhood cancers (National Cancer Institute)

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