Childhood Melanoma

Melanoma refers to a very serious type of skin cancer caused by the uncontrolled growth of melanocytes, also known as pigmented cells. Childhood melanoma refers to melanoma diagnosed in patients who are 18 years and younger. Those cases are quite rare.

Childhood melanoma has been classified into different types, such as melanoma present at birth (congenital melanoma), nodular melanoma, melanoma arising in patients who have atypical naevi, and spitzoid melanoma.

Melanoma in children ages 11 and older is quite similar to melanoma diagnosed in adults. It appears as a growing lesion that looks different from all other lesions. Most of these lesions are pigmented and 60% of reported cases correspond to the ABCDE+EFG criteria.

The ABCDE of melanoma is an acronym that has been developed to help clinicians and the public identify features in a skin lesion that may suggest an early or in situ melanoma.

• A stands for Asymmetry
• B stands for Border irregularity
• C stands for Colour variability/Change
• D stands for Different
• E stands for Evolving

The EFG of melanoma is another acronym that has been designed to help clinicians and the public identify skin changes in a lesion that may suggest a nodular melanoma. In this context, nodular refers to skin lesions that appear as bumps greater than 1 cm in diameter.

• E stands for Elevated
• F stands for Firm
• G stands for Growing

Superficial spreading melanoma is less common in children ages 10 and younger. Only 40% of cases have the ABCDE signs. Melanoma in young children is amelanotic (red coloured) and nodular.

Small congenital naevi are diagnosed in 1 of 100 births. These melanomas are quite rare and can be difficult to detect at early stages.

Risk factors for childhood melanoma include the following: presence of many moles, giant congenital naevus, history of retinoblastoma, immunodeficiency, and Fitzpatrick skin phototypes I-II.

Similar to the adult population, melanoma mainly affects Caucasian children and is closely linked with sun exposure.

Treatment options for childhood melanoma are the same as in adults. Lesions that are suspicious for melanoma are completely removed via initial diagnostic excisional biopsy. The clinical margin is usually 2 mm.

If a melanoma case is confirmed, a second surgical procedure is performed to remove a wider margin of normal skin. This procedure is called a wide local excision.

The prognosis of melanoma depends on the stage of melanoma. Survival rates among older children and adults are similar. However, melanoma cases in children who are 11 years and younger exhibit less aggressive behaviour in comparison with adults.