Incidence on the rise in adolescents

May 1, 2007

Pediatric melanoma is on the rise, and dermatologists should not hesitate to biopsy suspicious lesions in patients of any age. But prevention - via proper sun protection - is also vital, and must be emphasized early and often.

Key Points

"What we need to remember is that most melanoma is preventable with the adoption of proper sun-protective habits. Therefore, patients at risk for developing melanoma should be counseled early and the counseling reinforced at follow-up visits. Dermatologists should be leading the sun protection campaign and use office visits to relay this message," she says.

"We are seeing an increase in post-pubertal (adolescent) cases of melanoma," says Elizabeth Alvarez Connelly, M.D., assistant clinical professor of dermatology, department of dermatology and cutaneous surgery, and assistant clinical professor, department of pediatrics, division of pediatric dermatology at University of Miami Miller School of Medicine, Miami.

Australian and European studies suggest the increase in postpubertal melanoma, according to Dr. Connelly. But the rate of melanoma in prepubescent (childhood) years has not been shown to be increasing, and it is still quite rare.

Anthony J. Mancini, M.D., associate professor of pediatrics and dermatology, Northwestern University Feinberg School of Medicine, Chicago, and head, division of pediatric dermatology, Children's Memorial Hospital, Chicago, agrees that pediatric melanoma is a growing problem.

"There appear to be an increasing number of cases of malignant melanoma recognized in children over the last decade," Dr. Mancini tells Dermatology Times. "Moreover, recognition of this diagnosis in a child may be delayed because there is the traditional belief that melanoma does not occur in pediatric patients."

Experts suspect that poor sun protection habits throughout childhood could be to blame for some of the suspected increase in melanoma during adolescence.

Age-appropriate research sparse

With regard to the treatment of childhood melanoma, the standard of care is the same as it is for adults, and there are no specific or alternative regimens, according to Dr. Connelly.

One problem is that research focused on children is lacking.

"Trials of therapies for pediatric melanoma are few in number, and in fact, most treatment protocols that are recommended are based on extrapolation of adult therapies," Dr. Mancini says.

Among the few studies on the topic is one published Feb. 15, 2005, by Navid F. et al in Cancer, involving 15 pediatric subjects. This particular study concluded that high-dose adjuvant interferon alpha-2b for four weeks followed by a lower-dose maintenance phase for 48 weeks was feasible and tolerated in children with stage 3 melanoma. Shah N. C. et al reported in August 2006 in the Journal of Pediatric Hematology and Oncology that sentinel lymph node biopsy is feasible and safe in pediatric melanoma and offers the potential to identify patients at high risk for disease progression, and who thus might benefit from high dose interferon.

The bottom line

Dermatologists need to know that melanoma does occur in childhood, albeit quite rarely, Dr. Connelly says.

"If you see a suspicious lesion in a child, it should be biopsied and sent for histopathologic examination. Fear of performing a biopsy should not delay diagnosis," she says.

Having a high index of suspicion of pediatric melanoma should prompt dermatologists to biopsy or excise suspicious lesions even if it merely crosses their minds that something could be wrong, Dr. Mancini contends.

And dermatologists should not always look for the classic melanoma signs when examining pediatric patients.

"Many still expect that pediatric patients with melanoma will present with the typical features, i.e., a brown/black/blue nodule with ulceration. However, there are more and more reports highlighting the fact that pediatric melanoma may present as a red papule or nodule. In fact, many are misdiagnosed clinically as a vascular lesion," Dr. Mancini says.

Helping sun safe message sink in

Dr. Connelly starts sun protection counseling with parents when their children are infants. Then she tailors her suggestions as the children grow and become more active.