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The rise of melanoma in kids

Conquest - Summer 2014

As awareness of the pediatric cancer grows, so do efforts to teach valuable lifelong prevention habits at a young age

By Julie Penne

Photos: Wyatt McSpadden

When 14-year-old Kai Dunbar bursts out of the starting blocks while training with her high school track team, she has a single focus: crossing the finish line first.

It was that same philosophy of pushing on to the finish that brought Kai through a rare diagnosis of malignant melanoma, news that she and her family received when she was only 9 years old.

Born with a mole on her right cheek, Kai says the mark grew and eventually spread behind her ear. When it started bleeding and itching, her mother knew the changes were unusual and took her daughter to a dermatologist. After a biopsy and initial diagnosis, the dermatologist recommended the Dunbars go to
MD Anderson Children’s Cancer Hospital for specialized care. In the five years since, Kai has had three surgeries and several rounds of the immunotherapy drug interferon, which uses an antiviral protein produced by the body. She experienced a number of difficult side effects and was away from school for a full year. Now an incoming sophomore at Manvel High School, a halfhour’s drive south of Houston, Kai comes back to the children’s hospital outpatient clinic once a year for checkups, scans and labs.

Kai’s experience with the most deadly form of skin cancer has given her a new role among her growing social circle. In addition to hanging out with her friends, going to movies, performing hip-hop dance and running track, Kai is an advocate for sun protection and a walking example of why prevention and awareness are so vital.

“I try not to think about my cancer experience too much, but I always tell my friends to wear their sunscreen, be aware of any unusual moles, warts or freckles on their skin, and stay in the shade whenever possible,” she says. “When I tell them what happened to me, they’re shocked. They’ve never met anyone their age who’s been diagnosed with or survived cancer, let alone a cancer that is so much more common in adults.”

A rare diagnosis comprising about 3% of all childhood cancers, pediatric melanoma is on the rise in the United States. According to the American Academy of Dermatology, the number of cases diagnosed in the U.S. each year has doubled since 1973, from less than 250 cases to about 500 today.

But even as the number of diagnoses increases, the American Cancer Society reports that treatment may be delayed in up to 40% of cases, often due to a low level of awareness that the disease can affect children.

Dennis Hughes, M.D., Ph.D., associate professor in Pediatrics at Children’s Cancer Hospital, can attest to the increased cases — and the need for greater awareness of melanoma in children.

Hughes, who came to MD Anderson in 2004, sees an average of 16 new cases each year. His patients range in age from toddlers to teens and represent a variety of ethnic backgrounds.

Hughes and his Children’s Cancer Hospital colleagues are among a handful of pediatric oncologists in the U.S. who provide specialized care for children with melanoma. Over the past decade, no patient diagnosed with melanoma under the age of 18 and treated at the children’s hospital has been lost to the disease, which is well above the national average. According to Hughes, it’s a combination of experience, expertise and a more aggressive approach to treatment — along with a child’s young and more-responsive immune system — that have led to the positive outcomes over the years.

“Deaths due to pediatric melanoma are preventable through early screening, the proper use of sunscreen and decreasing exposure to dangerous ultraviolet (UV) rays, which can come from the sun or tanning beds,” Hughes says. “A child doesn’t have to be fair-skinned and light-haired to be diagnosed with melanoma. It’s important for parents to tune in to an unusual mole or wart and behaviors that may increase risk.”

Teaching, encouraging and practicing positive sun protection habits can pay off for children now and later in life. And teaching sun safety to children and teens can remind adults about the lifelong risks of melanoma.

“Instilling strong habits of sun protection not only keeps children safe now, but it also helps reduce risk in their adult years,” Hughes says. “We know that bad sunburns as a child can increase the risk of melanoma later on, so let’s teach our kids now about the importance of wearing sunscreen, playing on a playground or swimming at a pool shaded by a cover, staying away from tanning beds and doing skin checks regularly. These truly are life lessons.”

Tips for sun protection from Children’s Cancer Hospital

  • Consider multiple sunscreens for the family, not just one bottle for everyone to share. Let kids select their own sunscreen to make sure it’s something they’ll wear. Take into consideration that some kids don’t like fruity or floral scents and some don’t like a greasy feel. The most effective sunscreen for children is one they’ll wear properly.
  • It’s not necessary to wear a sunscreen with an SPF greater than 30. Higher SPF numbers really don’t mean anything in terms of protection.
  • Look for play areas with a protective cover or shade, but still apply sunscreen.
  • Apply sunscreen to your child before putting on his or her bathing suit for the pool or beach.
  • Always pack wide-brimmed hats, umbrellas or shades, sunscreen, sunglasses and protective clothing when heading outdoors.
  • Stay indoors between 10 a.m. and 3 p.m., the sun’s peak hours.
  • Babies less than 6 months old should be completely shielded from direct sun exposure.
  • Talk to your children and teens about the importance of sun safety.

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© 2015 The University of Texas MD Anderson Cancer Center