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Melanoma is a type of skin cancer most often seen in adults. However, although rare, melanoma affects about 300-400 children and adolescents each year in the United States. Melanomas can develop on any part of the skin. They can also occur in the eye. If left untreated, melanoma can spread to other parts of the body.
In melanoma, cancer forms in skin cells called melanocytes. Melanocytes produce melanin which provides color (pigment) to the skin.
Melanin is a pigment produced by certain skin cells called melanocytes. Melanin helps protect the skin from ultraviolet (UV) radiation from the sun. People with darker skin color have more melanin and are less likely to develop melanoma.
Although usually thought of as an adult disease, melanoma accounts for about 1% of cancers in children under age 15 years. It occurs more often in older age groups, accounting for 7% of cancers in adolescents ages 15-19 years.
Symptoms of melanoma include unusual skin changes such as a mole that grows in size, changes color, bleeds, or itches. Melanomas can also appear as a pale or red colored bump.
Treatment for melanoma depends on the stage of disease. Usually melanoma patients are treated with surgery to remove the cancer. More severe disease may require additional treatment including targeted therapy, chemotherapy and/or immunotherapy.
When caught early, survival rates for melanoma are very good. However, melanoma can spread to lymph nodes and other parts of the body, which can make it hard to treat. For this reason, awareness and early detection of melanoma is very important.
Certain factors increase the risk for melanoma. These include having fair skin that burns easily, certain skin conditions, a family history of melanoma and/or unusual moles, and a history of sun exposure or sunburns. Melanoma is more common in adolescents.
Signs of melanoma include changes to the skin including:
A helpful way to think about signs of melanoma is to remember the ABC’s:
B: Border irregularity
C: Color variation
D: Diameter (> 5 millimeters)
E: Evolution or Evidence of change
Several types of procedures and tests are used to diagnose melanoma. These include:
If doctors are concerned that melanoma may have spread, additional tests may be needed. These include:
There are several subtypes of melanoma:
Spitzoid melanoma is the most common type of melanoma that is seen in younger patients.
Melanoma is classified as Stage I or II (melanoma in skin only), Stage III (melanoma has spread to lymph nodes), or Stage IV (metastatic melanoma).
Factors that determine melanoma stage include:
Melanoma in situ: Abnormal melanocytes are found in the outer layer of the skin only
Melanoma thickness 1 millimeter or less; no ulceration
Melanoma thickness >4 millimeters with ulceration
Melanoma has spread to other parts of the body including lung, liver, brain, bone, soft tissue, or distant sites on the skin
The chance of recovery from melanoma depends on a variety of factors such as:
Overall, the stage of disease is the most important factor for prognosis. Patients with localized melanoma that has not spread have an excellent prognosis with survival rates greater than 90%. However, patients with distant spread of disease are more difficult to treat.
Treatment for melanoma depends on the location of the melanoma, features of the tumor (gene changes and histology), and stage of disease.
Surgery is the main treatment for melanoma. Melanoma may penetrate multiple layers of the skin. In order to remove all of the cancer, a large area of skin may be removed around the melanoma. A skin graft may be needed to close the wound. Lymph node biopsy and removal of lymph nodes (dissection) may also be needed. Patients with localized tumors (Stage I and II) that have not spread may be treated with surgery alone.
If melanoma has spread to lymph nodes or other parts of the body, additional treatments are needed including, immunotherapy and/or chemotherapy.
Immunotherapy uses the body’s own immune system to kill cancer cells. A variety of immunotherapy agents are being studied in melanoma. Some of the medicines act to block the signals that control the growth of cancer cells. Other agents use special proteins that attach to cancer cells so that immune cells are then able recognize and kill the cancer.
Targeted therapies are drugs that work by acting on, or targeting, specific features of tumor cells such as genes and proteins. Some melanoma patients have a change or mutation in the BRAF gene. This causes cells to make an abnormal protein. Drugs that block the abnormal BRAF protein include BRAF inhibitors (vemurafenib, dabrafenib) and MEK protein inhibitors (trametinib, cobimetinib). About half of melanomas involve a BRAF mutation, and targeted therapy may be helpful for these patients.
Chemotherapy (“chemo”) may be used to treat metastatic melanoma. However, melanoma does not always respond to chemotherapy. Depending on the location of the tumor and stage of disease, chemotherapy may be systemic or regional. Systemic chemotherapy works throughout the body. It may be given by injection or taken by mouth. Regional chemotherapy works mainly on cancer cells in one area of the body.
Radiation therapy may be used to treat melanoma that has spread to lymph nodes or other parts of the body like the brain.
Children may be offered treatment for melanoma as part of a clinical trial.
Survivors of melanoma are at higher risk for recurrence. Melanoma survivors should have regular exams by a dermatologist at least every 6 months. Survivors should check their skin regularly and see a doctor at any sign of change. Here are some simple ways to help prevent melanoma:
View the Kid’s Guide to Self-Screening from the Melanoma Research Foundation.
Do you know how to slip, slop, slap? Find out more about sun safety:
For general health and disease prevention, all cancer survivors should adopt healthy lifestyle and eating habits, as well as continue to have regular physical checkups and screenings by a primary physician at least yearly.
Childhood cancer survivors treated with chemotherapy or radiation should be monitored for acute and late effects of therapy.
Reviewed: June 2018