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 percent per year since 1973, although its incidence seems to have decreased over the last few years.
- The most significant 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.
- 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.
Although treatment options for children with melanoma are similar to those used for adults, a pediatric center will know how to best tailor treatment to children's needs. At Dana-Farber/Boston Children's Cancer and Blood Disorders Center, our Rare Tumors Program have unique expertise and access to treatment options that might not be available at other centers.
Risk Factors and Symptoms of Childhood Melanoma
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
While melanoma in adults tends to turn darker, it is often whitish, yellowish, or pink in children. 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
How We Diagnose Childhood Melanoma
If you see changes in the number, size, shape, and color of pigmented areas on your child, it is important to see your doctor.
We use the "ABCDE rule" to determine whether a doctor should check a mole in children and teenagers. In children and teens, color may be lighter instead of darker.
- A for asymmetry: One half is shaped differently 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. Remember that melanoma can occur in places not exposed to the sun. Confirm that your doctor also checks your child's scalp, feet, hands, and buttocks.
In addition to a complete medical history and physical examination, we diagnose melanoma with a biopsy of the lesion. It is crucial to have your child's biopsy reviewed by a pediatric team. Dermatologists and pathologists that primarily diagnose adult melanoma may not notice key signs of melanoma in children.
How We Treat Childhood Melanoma
Low-stage melanoma is treated primarily with observation. Other common treatments include:
- Surgery: We remove the entire melanoma and any cancerous lymph nodes where the disease spreads. Some melanomas can be removed easily and require only minor surgery, while others may require a more extensive surgical procedure.
- Chemotherapy: We may use chemotherapy treatment if the disease spreads to the lymph nodes or other organs.
- Radiation therapy: This treatment is another option if the cancer spreads to the lymph nodes.
- Immunotherapy: We introduce molecules to your child's system that can train their immune system to attack the cancer cells.
After treatment, we continue to care for your child through our pediatric cancer survivorship programs. Our medical experts support you and your family in the transition to survivorship and throughout your long-term care needs.
Research and Clinical Trials for Childhood 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, we may select drugs that match the tumor profile. Immunotherapy for melanoma works by unleashing a very swift and sustained immune system response against melanoma cells.
Long-term Outcomes 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. We expect about 60 percent of children whose disease has spread to the lymph nodes to survive long-term.
Studies show that children treated for melanoma are at increased risk for disease recurrence later in life. Frequent medical checkups are important as children become adults.
Childhood Melanoma Treatment Team
At Dana-Farber/Boston Children's, we have a multidisciplinary solid tumor treatment that has the experience to diagnose and treat children with melanoma. We work together and with you and your family to determine the best options for your child's needs.
See a complete list of the specialists in our Childhood Solid Tumor Center.