Melanoma

What is skin cancer?

Skin cancer is a malignant tumor that grows in the skin cells. In the U.S. alone, more than 2 million Americans will be diagnosed in 2013 with nonmelanoma skin cancer, and more than 76,000 will be diagnosed with melanoma, according to the American Cancer Society.

Fortunately, skin cancers (basal cell and squamous cell carcinoma, and malignant melanoma) are rare in children.

What causes skin cancer?

Exposure to sunlight is the major contributing factor to developing skin cancer later in life. In particular, blistering sunburns in childhood and adolescence significantly increase the risk of developing malignant melanoma later in life.

Limiting exposure to sunlight in children and teens may pay large dividends in preventing skin cancers later in life.

Prevention & Risk Assessment

Prevention & Risk Assessment

What are the risk factors for skin cancer?

Skin cancer is more common in fair-skinned people, especially those with blond or red hair, who have light-colored eyes. Skin cancer is rare in children. However, no one is safe from skin cancer. Other risk factors include:

  • Family history of melanoma
  • Prior history of skin cancer 
  • Sun exposure. The amount of time spent unprotected in the sun directly affects your child's risk of skin cancer.
  • Early childhood sunburns. Research has shown that sunburns early in life increase a child's risk for skin cancer later in life. Sun exposure early in life is a major contributing factor to developing skin cancer.
  • Many freckles
  • Many ordinary moles (more than 50)
  • Dysplastic nevi
  • Prior radiation therapy 
  • Lowered immunity, such as in people who have had organ transplants 
  • Certain rare, inherited conditions such as basal cell nevus syndrome (Gorlin syndrome) or xeroderma pigmentosum (XP) 

Prevention of skin cancer

The following steps have been recommended by the American Academy of Dermatology (AAD) and the Skin Cancer Foundation to help reduce the risk of sunburn and skin cancer:

  • Minimize exposure to the sun at midday, between the hours of 10 a.m. and 4 p.m.
  • Apply sunscreen with an SPF-30 or higher that protects against both UVA and UVB rays, to all areas of your child's (older than 6 months of age) body that are exposed to the sun.
  • Reapply sunscreen every two hours, even on cloudy days. Reapply after swimming or perspiring.
  • Use extra caution near water, snow, and sand. They reflect the damaging rays of the sun, which can increase the chance of sunburn.
  • Make sure your child wears clothing that covers the body and shades the face. Hats should provide shade for both the face, ears, and back of the neck. Wearing sunglasses will reduce the amount of rays reaching the eye and protect the lids of the eyes, as well as the lens.
  • Avoid exposure to UV radiation from sunlamps or tanning parlors.
  • Protect children from excessive sun exposure when the sun is strongest (between 10 a.m. and 4 p.m.) by having them play in the shade, wear protective clothing, and use sunscreen liberally and frequently for children 6 months of age and older.
  • Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't seek the sun.

The American Academy of Pediatrics approves of the use of sunscreen on infants younger than 6 months old if adequate clothing and shade are not available. Parents should still try to avoid sun exposure and dress the infant in lightweight clothing that covers most surface areas of skin. However, parents also may apply a minimal amount of sunscreen to the infant's face and back of the hands.

Remember, sand and pavement reflect UV rays even under an umbrella. Snow is a particularly good reflector of UV rays.

How to perform a skin examination

Finding suspicious moles or skin cancer early is the key to treating skin cancer successfully. Examining your children (and yourself) is usually the first step in detecting skin cancer. The following suggested method of examination comes from the AAD:

  • Examine your child's body front and back, then the right and left sides, with arms raised.
  • Look carefully at your child's forearms, the back of his or her upper arms, and the palms of the hands. Check between the fingers and look at the nail beds.
  • Look at backs of his or her legs and feet, spaces between the toes, the toenail beds, and the soles of the feet.
  • Examine the back of his or her neck and scalp.
  • Check his or her back, buttocks, and genital area.
  • Become familiar with your child's skin and the pattern of moles, freckles, and other marks.
  • Be alert to changes in the number, size, shape, and color of pigmented areas.
  • Follow the ABCD Chart when examining moles of other pigmented areas and consult your child's doctor promptly if you notice any changes.
Diagnosis

Diagnosis

What are the different types of skin cancer?

There are three main types of skin cancer, including:

  • Basal cell carcinoma: Basal cell carcinoma accounts for the majority of all diagnosed skin cancers. This highly treatable cancer starts in the basal cell layer of the epidermis (the top layer of skin) and grows very slowly. Basal cell carcinoma usually appears as a small, shiny bump or nodule on the skin, mainly those areas exposed to the sun, such as the head, neck, arms, hands, and face. It more commonly occurs among people with light-colored eyes, hair, and complexion.
  • Squamous cell carcinoma: Squamous cell carcinoma, although more aggressive than basal cell carcinoma, is highly treatable. It accounts for a much smaller percentage of all skin cancers. Squamous cell carcinoma may appear as nodules or red, scaly patches of skin, and may be found on the face, ears, lips, and mouth. Squamous cell carcinoma can spread to other parts of the body, although this is rare. This type of skin cancer is usually found in fair-skinned people.
  • Malignant melanoma: Malignant melanoma accounts for a small percentage of all skin cancers, but accounts for most deaths from skin cancer. Malignant melanoma starts in the melanocyte cells that produce pigment in the skin. Malignant melanoma sometimes begins as a mole that then turns cancerous. This cancer may spread quickly. Malignant melanoma most often appears on fair-skinned men and women, but people with all skin types may be affected.

Distinguishing benign moles from melanoma

Sign Characteristic

Assymetry

When half of the mole does not match the other half

Border

When the border (edges) of the mole are ragged or irregular

Color

When the color of the mole varies throughout

Diameter

If the mole's diameter is larger than a pencil's eraser

To find melanoma early, it is important to examine your child's skin on a regular basis, and become familiar with moles, and other skin conditions, in order to better identify changes. According to recent research, certain moles are at higher risk for changing into malignant melanoma. Larger moles that are present at birth and atypical moles, have a greater chance of becoming malignant. Recognizing changes in your child's moles, by following this ABCD Chart, is crucial in detecting malignant melanoma at its earliest stage. The warning signs are:

Melanomas vary greatly in appearance. Some melanomas may show all of the ABCD characteristics, while others may show few or none. New moles, moles that have grown or changed, and moles that are itchy or bleeding should be checked by your child's doctor. Always consult your child's doctor if you have questions about a mole or other skin lesion.

Treatments

Treatments

What are the treatments for skin cancer?

Specific treatment for skin cancer will be determined by your child's doctor based on:

  • Your child's overall health and medical history

  • Type of skin cancer

  • Extent and location of the disease

  • Your child's tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

There are several kinds of treatments for skin cancer. Because skin cancer is much more common in adults, many of these treatments have not been studied extensively in children, although doctors may still use them: 

  • Surgery. Surgery is a common treatment for skin cancer. It is used in most treated cases. Some types of skin cancer growths can be removed very easily and require only very minor surgery, while others may require a more extensive surgical procedure.

    Surgery may include the following procedures:

    • Cryosurgery. Using liquid nitrogen, cryosurgery uses an instrument that sprays the liquid onto the skin, freezing and destroying the tissue.

    • Curettage and electrodesiccation. This common type of surgery involves scraping away skin tissue with a curette (a sharp surgical instrument shaped like a spoon), followed by cauterizing the wound with an electrosurgical unit.

    • Excision. A scalpel (sharp surgical instrument) may be used to excise (cut out) and remove the growth. The wound is usually stitched or held closed with skin clips (staples).

    • Mohs' microscopically controlled surgery. This type of surgery involves excising (cutting out) a cancer, layer by layer. Each piece of excised tissue is examined under a microscope. Tissue is progressively removed until no tumor cells are seen. The goal of this type of surgery is to remove all of the malignant cells and as little normal tissue as possible. It is often used with recurring tumors (those that come back after treatment).

  • Laser therapy. Laser surgery uses a narrow beam of light to destroy cancer cells, and is sometimes used for tumors located on the outer layer of skin.

  • Radiation therapy. X-rays are used to kill cancer cells and shrink tumors. Radiation is not a common treatment for skin cancer, but it may be used for skin cancer in areas where surgery could be difficult or leave a bad scar.

  • Photodynamic therapy. Photodynamic therapy uses a certain type of light and a special chemical to kill cancer cells. 

  • Other types of treatment include the following:

    • Chemotherapy. Chemotherapy uses drugs to kill cancer cells.

      • Topical chemotherapy. Chemotherapy given as a cream or lotion placed right on the skin to kill cancer cells.

      • Systemic chemotherapy. Chemotherapy administered orally (by mouth) or intravenously (into a vein) for more advanced skin cancers.

    • Immunotherapy. Immunotherapy treatment for melanoma is a complex type of treatment involving various approaches to boost the body's own immune system, helping it to attack the cancer. Some types of treatment can be applied right on tumors or injected directly into them. Other types are used for more advanced cancers and are given intravenously. 

    • Targeted therapy. Some medicines used to treat advanced skin cancers work by targeting specific parts of the cancer cells. These medicines can often be taken as a pill. 

Treatment Services

Pediatric Cancer Surgery

Our expert surgical oncology team provides the full spectrum of surgical treatment for children with cancer.

Pediatric Chemotherapy

Chemotherapy is the use of anticancer drugs to treat cancer cells.

Pediatric Radiation

Radiation therapy (also called radiation oncology) uses special kinds of energy waves or particles to fight cancer.

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Washington, District of Columbia 20010

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