Melanoma: What Parents Need to Know

Did you know that May is Melanoma Awareness Month?

Melanoma is the most serious form of skin cancer and if left untreated can lead to death.  If caught in its early stages, though, there are multiple treatments that can improve outcomes. Many people think that only adults get melanoma, but in fact melanomas also occur in children at a rate of close to 500 per year.

With summer approaching, it’s the perfect time of year to have your child’s moles examined by a qualified professional. A board certified pediatric dermatologist is specifically trained to detect abnormal moles and skin cancers in babies, young children, adolescents, and young adults. Many people do not realize that abnormal moles can look different in children than they do in adults. For example, atypical moles in children can present as a bleeding mole, a red bump, or they can even look similar to a wart. Pediatric dermatologists use their specialized training, experience and a magnifying tool called a dermatoscope to detect these skin lesions.

Should my child be seeing a pediatric dermatologist for an annual mole check?
If your child has not yet developed any moles or simply has a few tiny, light brown moles that all match one another, then your pediatrician may be comfortable monitoring these. If, however, your pediatrician is not comfortable or if your child has any of the following, then he/she could be at a greater risk of developing atypical moles, skin cancer or melanoma and should be examined at least once per year by a board-certified pediatric dermatologist:

• A large mole that has been present since birth
• History of any blistering sunburn or intermittent intense sun exposure
• Freckling
• Fair skin, light eyes, or hair color
• History of immune suppression or radiation
• Family history of skin cancer (such as basal cell or squamous cell carcinoma and especially melanoma)

What can I do to decrease my child’s risk of melanoma?
Since we cannot control our genetics, sun protection is the single most important way to decrease your and your child’s risks of developing melanoma.

• The American Academy of Pediatrics recommends that babies UNDER 6 months avoid direct sun exposure on their skin by dressing in lightweight long pants, long-sleeved shirts, and wide-brimmed hats. However, if this does not shade all areas of the skin then parents should follow the instructions below and apply the sunscreen to the small exposed areas of skin that are not covered by clothing (face, tops of hands).

• Use a product that is “broad spectrum”, meaning that it blocks both UVA (aging) rays and UVB (burning) rays. UVA rays can penetrate glass, which is why you should apply a sunscreen to the face and exposed areas every day (even on days that might be cloudy).

• Apply and then reapply the sunblock with SPF at least 15 every 2 hours or more often if you are sweating or swimming (even on cloudy days). Use extra caution near water and sand, which reflect the sun’s rays and can more easily lead to a burn more quickly than parents expect.

• Find shade and avoid direct sunlight between 10 a.m. and 2 p.m. (when your shadow is shorter than you are).

• Avoid tanning beds. Self-tanner is a safe alternative.

How can I tell if my child might have an abnormal mole that needs to be urgently evaluated?

Most moles in children are benign, but they can pose a future risk for the development of skin cancer. As a supplement to a thorough annual exam by a pediatric dermatologist you should also perform your own monthly skin examinations at home looking for any moles that meet the “ABCDE” screening criteria. These criteria were developed by the American Academy of Dermatology in order to help patients decide if there are any unusual moles that require a professional examination.

The “ABCDE criteria” for detecting abnormal moles that require further evaluation:

• A: Asymmetry: one half of the mole is unlike the other half
• B: Border: an irregular, scalloped or poorly defined border
• C: Color: varied colors from one area to another; shades of brown, black, white, blue, or red
• D: Diameter: greater than the size of a pencil eraser (6 mm)
• E: Evolving: any mole that looks different from the others or is changing in size, shape or color, or itching or bleeding

Diameter is the least important criterion, as many melanomas can begin as lesions that are much smaller than a pencil eraser and should not be ignored. If you or your child has an odd-looking or changing mole, never hesitate to have that early lesion evaluated right away, even if it happens to be smaller than a pencil eraser. Most experts agree that the “E” for “evolving” is the single most important sign of a worrisome mole. The “ugly duckling” rule advises that any mole which doesn’t look like the rest or is exhibiting symptoms that are different from the rest should be immediately evaluated. In addition to a change in color or size, other symptoms such as bleeding, crusting, itching, or pain may signal a mole becoming abnormal. As outlined above, abnormal moles in children can be red or even look similar to a wart. If your child has a mole that concerns you, please call our pediatric dermatologists to get an appointment right away.

How can I make my child’s annual mole check visit more comfortable for him/ her?
Many young children and adolescents prefer to wear one or two-piece swim suits under their clothing the day of their visits with the pediatric dermatologist so that they don’t feel self-conscious or “naked”. Anything you can do to make this visit more comfortable for them is well worth your while, as it will help them develop anxiety-free routines of having their moles checked once per year; this is just as important a habit for them to establish as the routine of regular dental or medical checkups.

Welcome this summer season with skin that you know is healthy by visiting your pediatric dermatologist for a complete mole check and discussion of any other problems you may be experiencing with your skin so that your children look and feel their absolute best. Teach them healthy habits now, at a young age, that they will keep for the rest of their lives. When it comes to moles and skin cancer, it may someday make the difference between life and death.  Call 724-933-9190 or securely email ccpderm@chp.edu to request an appointment.

What do I do if my child gets diagnosed with an atypical mole (also known as an atypical melanocytic tumor) or a melanoma?  Does Pittsburgh have pediatric melanoma specialists?
Diagnosing and treating children with melanoma and related atypical moles requires an experienced team with specialized training in this area. Since melanoma is the most common form of skin cancer in children, Children’s Hospital of Pittsburgh of UPMC has developed a specific Pediatric Melanoma Center, where we approach each child or adolescent individually and coordinate our expertise to provide the best advice and care possible.  The different doctors in our center include:

• Dr. Brittani Seynnaeve, M.D., M.S. –  Director, Pediatric Melanoma Program
• Dr. John M. Kirkwood, M.D. – Co-Director, Pediatric Melanoma Program; Co-Leader, Hillman Melanoma Program
• Dr. Alexander Joseph Davit III, M.D. – Director, Pediatric Hand Surgery Program and Pediatric Wound Care Clinic
• Dr. Robin P. Gehris, M.D. –  Chief, Pediatric Dermatology
• Dr. Marcus Malek, M.D. – Director, Pediatric Surgical Oncology
• Katherine Glovier, Specialty Care Coordinator, Pediatric Melanoma Center

Please visit our website to learn more about the Pediatric Melanoma Center at Children’s Hospital of Pittsburgh of UPMC.