Melanoma
Introduction
Melanoma (mel-eh-NOE-muh) is a skin cancer that occurs when melanocytes (pigment making cells in the skin) turn cancerous. It is more likely to spread from the skin to other areas of the body and therefore more life threatening than other types of skin cancer. Fortunately, it is not common in children.
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Melanoma on the back
Who gets it?
Anyone can develop a melanoma, including children. But melanoma is more likely in adults than children.
Some of the common risk factors for developing melanoma include children with:
fair complexion (pale skin, freckling, easily sunburnt skin)
blonde or red hair
light coloured eyes (blue, green)
many moles (especially many unusual moles)
lots of sun exposure
many sunburns
a family member with melanoma (especially at a younger age) or many funny moles (dysplastic naevus syndrome)
rare genetic conditions
What causes it?
Skin has cells called melanocytes that create melanin, which is the pigment that is found in skin, hair and eyes. When these cells start to grow abnormally, they can become a melanoma. You are likely to notice them in your child as a new mole or a raised wart-like bump. Melanomas begin by growing on the top layer of the skin but will quickly start to grow deeper into the skin. Once they are in the deeper layers of the skin, they can break into the blood or lymphatic vessels, which can then carry the cancer cells to other areas of the body.
Sun exposure is the biggest risk factor for melanoma in children as it is in adults. Uncommonly there is an inherited genetic problem that can cause melanoma in children and young adults.
What does it look and feel like?
In children and teenagers, melanoma can look different to what it does in adults.
Looks like…
A bump on the skin that can itch or bleed
A bumpy spot that can be yellow, white, red or pink in colour (children are more likely to develop melanomas that are not black or brown)
A patch of skin that is darker than the rest of your child's skin
A strange or changing mole
A scaly, crusty or bleeding area on your child's skin that won’t heal
Feels like…
Usually there are no symptoms
Occasionally itch or pain
Raised, smooth or wart like bumps
What tests might be needed?
It is important to see a doctor if your child has a new mole, or a mole that is not like all the other moles on their body. A dermatologsit will look at your child's mole under a special microscope. They will look at the characteristics of the mole such as the shape, colour and size. If suspicious of a melanoma, they may take a sample of your child's skin (skin biopsy) to look at it at under the microscope. Most times, they will remove the whole mole and some of the normal skin surrounding it.
Rarely, the dermatologist may also refer you to other specialists and order futher tests such as MRI to rule out any other complications.
What treatments are available?
If your child has a melanoma, it is important to have it treated. Treatment will not be the same for every child and depends on your child's melanoma subtype.
What can I do?
Check your child's skin regularly for any changing moles or new spots.
Tell your doctor if you find a new mole on their body.
Prevention is key and good sun protection is vital life long. (Refer to sun protection and sun screen fact sheet.)
Medical therapies
Wide local excision - once a melanoma is confirmed, a second surgery is required to remove more of the surrounding skin to ensure that there are no cancer cells remaining. The amount of surrounding skin removed depends on the type of melanoma. This surgery is usually performed by a paediatric plastic surgeon.
Sentinel node biopsy - sometimes the lymph nodes nearest to the cancer maybe removed for testing to find out if the cancer has started to spread beyond the skin.
Chemotherapy- when cancer has moved to other parts of the body, occasionally medicines are used to stop the melanoma from growing.
Radiation therapy- rarely high energy radiation is used to destroy cancer cells.
Immunotherapy- when cancer has moved to other part of the body, medications are given to activate your child's own immune system to destroy melanoma cells.
What happens after treatment?
If your child had a melanoma, they are at risk of developing more melanomas throughout their life. So your child should have their skin checked regularly by a dermatologist. The regularity of the screening is usually determined by the subtype of melanoma but usually a screening is recommended at least every 6 months.
Occasionally, the dermatologsit may refer your child to a special genetic clinic if they suspect the cause of their melanoma is due to a rare genetic issue.
What support is available?
You can be supported by your general practitioner or a dermatologist. Websites: https://www.dermnetnz.org/topics/childhood-melanoma/ https://childrenscancer.canceraustralia.gov.au/types-childrens-cancers/melanoma
Authors/Reviewers:
Author: Dr Claudia Hadlow
Paediatric Reviewer: Dr Mayuri Sivagnanam
Photos courtesy of Dr Deshan Sebaratnam
Editor in Chief: Dr Tevi Wain
