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Melanoma Is Not for Adults Only

CancerWise - July 2008

By Dawn Dorsey

Chloe Fowlkes with her mom, Missy

Chloe Fowlkes has a lot in common with many 8-year-olds: She likes running, playing outside and tormenting her younger sister. But she’s in a small minority in one important category.

Chloe has melanoma, a type of skin cancer that's diagnosed in about 600 children each year. Some people have the misconception that melanoma occurs only in adults, but pediatric melanoma accounts for 1% of new melanoma cases in the United States.

Parents need to be aware

Dennis Hughes, M.D., Ph.D., assistant professor in M. D. Anderson’s Division of Pediatrics, treats about a dozen children with melanoma each year in the Children’s Cancer Hospital at M. D. Anderson.

Hughes says melanoma is:

  • More prevalent than other pediatric skin cancers
  • Usually found in children 10 years old or older
  • Slightly more common in girls
  • Faster-growing in children than in adults

Chloe’s cancer first appeared as a small, scaly bump that resembled a mosquito bite. When it didn’t go away and, in fact, grew to marble size, Chloe’s mother, Missy Fowlkes, took her to the pediatrician. He didn’t suspect anything serious, and he referred them to a plastic surgeon to have the growth removed.

“Chloe had never had a sunburn, and we don’t have skin cancer in the family,” Fowlkes says. “I really didn’t expect it to be any big deal.”

Diagnosis comes as surprise

As a matter of routine, the surgeon sent the growth to be analyzed. The results were inconclusive.

“Then everything just started rolling,” Fowlkes says. “They sent it to the Mayo Clinic, and specialists there also found the results inconclusive. The plastic surgeon said that although he wasn't sure, he suspected a melanoma, and he referred us to
M. D. Anderson.”

In January 2008, the Fowlkes had a firm diagnosis of melanoma. Three surgeries followed, including one to remove lymph nodes under Chloe’s arm that turned out to be noncancerous.

Be sure to check children

The message for parents, Hughes says, is to be aware. If parents find a suspicious mole or growth, they should take their child to a pediatric dermatologist for a thorough skin examination.

Hughes advises parents to:

  • Be aware of odd-looking moles, especially large ones
  • Watch for moles/marks that change size
  • Remember ABCD:
    • Asymmetry
    • Border irregularity
    • Color
    • Diameter
  • Watch for moles larger than a pencil eraser
  • Look for moles that look different from others
  • Watch for wart-like moles (not colored or pink)

Melanoma risk factors include having:

  • Fair skin, freckles, or red or blond hair
  • Many irregular or large moles
  • A close relative with the disease
  • A previous melanoma

Be proactive to keep kids safe

While pediatric melanoma is not believed to be directly related to sun exposure, three severe sunburns before age 18 increase the lifetime risk of melanoma fivefold, Hughes says. Nearly 80% of lifetime sun exposure occurs by age 18.

Parents can help lower the risk by protecting their children from the sun’s harmful rays and teaching them the facts about sun protection. This is information they can carry into adulthood.

Parents can help reduce cancer risk if they:

  • Fully cover babies less than 6 months old
  • Apply sunscreen to children 6 months old and older
  • Adjust outdoor play to early morning or late evening
  • Teach children to apply sunscreen before going outside
  • Lead by example by wearing:
    • Sunscreen
    • A broad-brimmed hat
    • Other protective clothing (shirts, pants)
  • Check moles regularly
  • Know that:
    • Clouds don't protect skin from the sun
    • Reflective surfaces multiply the sun's intensity
    • Sunscreen is not effective right away

It usually takes 30 minutes from the time sunscreen is applied before it becomes effective.

Worry doesn’t slow her down

Fowlkes says Chloe is sometimes concerned because she's part of a cancer minority.

“She has met adults with melanoma, but she has never met a child with it,” Fowlkes says. “Sometimes it brings her down. She asks her doctor, ‘Am I the only kid who has this?’”

But she doesn’t spend much time worrying about it. She’s too busy doing what most kids her age do. Unlike many, though, she’s the one reminding her mother about sunscreen, instead of the other way around.

“If Chloe’s going outside, she always stops and reminds me she needs sunscreen,” Fowlkes says.

M. D. Anderson resources:

© 2015 The University of Texas MD Anderson Cancer Center