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It's More Than Skin Deep

CCH Newsletter - Summer 2010


For years, children have been playing in the sun and teens and young adults have being taking in the rays to work on suntans. However, we’ve all learned that, while the sun makes the world appear happy and bright, it can also be a deadly enemy.

Aside from the healthy dose of vitamin D that sunshine provides, the consequence of UVA and UVB rays from the sun can be severe. For many adults, the build-up of skin damage caused by overexposure to the sun results in a form of skin cancer called melanoma. Occasionally, that same type of cancer is found in children.

Children Develop Melanoma, Too

Pediatric cancer in general is a rare disease. Each year, pediatric oncologists treat some 750 children up to age 20 for melanoma. Most of this disease is low stage, requiring only a biopsy and surgical removal. Some pediatric patients, however, may not receive the right care and follow-up for this cancer. To put this in perspective, these numbers are similar to those reported for pediatric osteosarcoma.

In the MD Anderson Children’s Cancer Hospital, Dennis Hughes, M.D., and Cynthia Herzog, M.D., report seeing approximately 12 melanoma patients each year who actually merit treatment. Most often, patients with a suspected melanoma are first evaluated and then treated surgically until there is no remaining evidence of the disease. With high-stage melanoma, interferon treatment is given five times per week for a month and then in reduced amounts for a year.

The best care for these patients is to make certain that the disease has not spread to the sentinel lymph node. Checking this involves two injections into the site of the biopsy. The first is with a lymphoscitigraphy, which is a radiotracer that sends a dye back to the involved lymph node or nodes. This allows the surgeon to determine which lymph node to remove. On occasion, an entire bed of lymph nodes must be taken out. This can change the way that fluids drain from that site and may eventually result in endema and then other cancers.

The second injection occurs on the morning of surgery when a blue colloid dye is shot into the site of the melanoma. The dye stains the relative lymph node blue so that it is easy to determine which one or ones to remove.

In children, most melanomas may be the result of a genetic predisposition. If a child gets a bad sunburn, it is usually 10 years before a melanoma appears, which is why the more typical sun-caused skin cancers are found in teens and those older. After treatment for an initial melanoma diagnosis, the greatest lifelong risk is that a new spot located somewhere on the body may become melanoma, not that the old one will reoccur.

Keeping Melanoma at Bay

The best form of treatment is prevention. As Hughes says, “If your skin has already figured out how to make a melanoma, why give it help?” His recommendation is to take the children along when shopping for sunscreen and other skin care products because it’s difficult to impose something on pediatric patients that they find objectionable.

For boys, the clear, alcohol-based product is usually a pleaser. Girls are fonder of the floral-scented sunscreens and can normally find several sunscreens that they will use. “The easier it is to apply, the happier the children are with it,” Hughes says. He also says that the spray-on variety works well as long as hands are used to spread it onto the body.

One caution is to apply sunscreen prior to donning a bathing suit. “If you put the sunscreen on at home before you go to the beach or pool, the half hour it takes to become effective will be passed by the time you arrive. You’ll also miss those ‘edge burns’ that you may get when you try to put on the sunscreen around your bathing suit,” Hughes explains.

Keep in mind the difference between sunscreen and sunblock. Sunscreen contains molecules that can absorb the sun’s energy and prevent it from getting into the skin. Sunblock is metal salt that reflects the sun’s energy away from the skin. Both are effective as long as they are reapplied every two to four hours.

Hughes recommends that everyone use a water-proof sunscreen with a minimum of a 30 spf, which is the measure of the proportion of UV light blocked. A 30 spf sunscreen means that 97% of the sun’s energy is blocked. With a 50 spf, 98 percent is blocked, and with an 85 spf, approximately 99% is blocked.

While sun-protective clothing and sunglasses are also good ideas, especially for younger children, a hat is a must. If you don’t have a hat, don’t forget the head when applying sunscreen, especially along parts in the hair. An alcohol-based product is best for the head because it is non-greasy.

Children with light coloring in their skin, hair and eyes are predisposed to melanomas, as are those with lots of moles, which are precursors to melanoma. However, even dark-skinned Latin Americans and African-Americans can get melanoma.

Finding, Diagnosing and Treating Melanomas

When checking for melanoma, look for the ABCDE danger signs in any moles or pigmented spots:

  • Asymmetry – one half is unlike the other half
  • Border – an irregular, scalloped or poorly defined border
  • Color – is varied from one area to another; has shades of tan, brown or black; is sometimes white, red or blue
  • Diameter – melanomas are usually larger than the size of a pencil eraser when diagnosed, but may be smaller
  • Evolving – a mole or skin lesion that looks different from the rest or is changing in size, shape or color

With children, it’s important to find a team that is experienced in diagnosing and treating pediatric patients with melanoma. This team should include a pediatric oncologist, an experienced melanoma dermatopatholgist who has experience doing a sentinel node analysis and a surgical oncologist who is experienced in sentinel node mapping and biopsy.

Most pediatric melanomas are treated with surgery. Those that are low-stage may only require observation after surgery; however, those melanomas that have spread to the lymph nodes may need additional treatment such as biologic therapy, chemotherapy or both. A diagnosis of pediatric melanoma requires lifelong skin checks and follow-up with an experienced melanoma oncologist.

As Hughes explains, there is no rewind button. “You can’t change the future possibility of having melanoma, but you can change how early you might develop melanoma. And, once you have a melanoma, you have an increased risk of having more.”

“There is no such thing as a safe skin,” Hughes says.


© 2014 The University of Texas MD Anderson Cancer Center