Melanoma is a type of skin cancer that is very rare in children under 10 years of age. Most cases of melanoma in children are diagnosed in teens aged 15-19 years.

Melanoma usually appears as a new, fast-growing black, brown, or pink bump. Pain, itching, bleeding, or crusting may also be present, but often there are no symptoms.

Diagnosis

Melanoma is diagnosed by a skin biopsy. This is a procedure in which part or all of the skin lesion is removed. It is usually done during an office visit. General anesthesia may be needed for younger children or for those who cannot have the procedure done in the office.

It can be very difficult to diagnose melanoma in a child since it is so rare. Also, several other types of moles (called melanocytic nevi) seen in children may mimic melanoma.

A common mimic of melanoma in children is a benign type of mole called a Spitz nevus. This mole usually appears as a fast-growing, pink bump. However, Spitz nevi may sometimes have unusual features when examined on a skin biopsy, which makes it hard to tell it apart from melanoma. In such cases, your child's healthcare providers will discuss whether any additional testing or treatment should be considered.

If a child is thought to have melanoma, he or she should see a medical specialist who has expertise in melanoma in children.

Cause

Melanoma is caused by genetic changes in the skin. These changes can also happen in an existing mole (melanocytic nevus).

Known risk factors for the development of melanoma include:

• blistering and / or recurrent sunburn.
• fair skin that burns but does not tan.
• freckling.
• red hair.
• blue or green eyes.
• presence of many (more than 100) moles.
• history of prior malignancy.
• family history of melanoma and /or pancreatic cancer in three or more family members.

Many children who develop melanoma have no risk factors.

Symptoms

A child may have pain, itching, bleeding, or crusting with a new or existing mole, although often there are no symptoms.

Treatment

Treatment is based on the results of the skin biopsy and any genetic testing done on the biopsy sample. Treatment usually begins with the removal of the melanoma, along with some normal skin around it. The amount of normal skin removed varies based on the size and depth of the melanoma. For thicker tumors, the surgeon may take a sample of the lymph nodes found near the melanoma site. This will tell if the melanoma has spread to the local lymph nodes.

If your child has enlarged lymph nodes when the diagnosis of melanoma is made, it is recommended to remove all of the lymph nodes in that area at the same time that the melanoma is surgically removed.

If your child has melanoma in the lymph nodes, or if they have symptoms that might suggest that the melanoma has spread, more tests may be recommended such as a CT scan, MRI scan or PET scan.

Symptoms that may suggest the melanoma has spread include:

• weight loss.
• cough.
• fatigue.
• nausea.
• abdominal pain.
• bone pain / aches.
• headache.
• mood or behavioral change.

If your child’s melanoma has spread to the lymph nodes or other body organs, your doctor will discuss whether other treatment is recommended. Treatment options include the use of chemotherapy medicines, as well as new medicines, called targeted therapies.

When to Call a Doctor

Call your doctor if:

• Your child develops a new mole that looks unusual or is associated with pain, itching, bleeding or crusting.
• Your child develops a new pink, brown, or black area of skin.
• A new lump or bump develops in or near the scar from their melanoma removal area.
• Your child develops any of the following symptoms:
  • Unexplained weight loss.
  • Persistent nausea and / or abdominal pain.
  • Chronic cough or shortness of breath.
  • Persistent headaches.
  • Bone pain / aches.
  • Mood or behavioral changes.