Childhood melanoma different from that of adults

A study suggests physicians be more alert to the possibility of skin cancer in children, but does not recommend increased screening.

By Victoria Stagg Elliott, AMNews staff. March 28, 2005.

Experts are calling on physicians who care for children to be alert to the possibility that unexplained lesions could be melanoma because of growing evidence that skin cancer is increasing in all age groups and that it might progress differently in younger patients.

"If a parent says something has changed or doesn't look right, it should be considered for further work-up," said Lynne Lillie, MD, a family physician with HealthEast Clinic in Woodbury, Minn. "And parents should be encouraged to bring up the issue to a physician."

Recently, a study in the March issue of Pediatrics suggested that melanoma in those younger than 14 is more likely to lack pigmentation, and the illness is more likely to be diagnosed at a later stage when lesions are thicker. This finding did not translate into increased mortality, and the authors of this study and an accompanying editorial are calling for increased alertness, although not necessarily more screening.

"We should avoid alarmism," said Andrea Ferrari, MD, lead author on the paper and a researcher with the Istituto Nazionale Tumori, Milan, Italy. "Primary care physicians must be aware that melanoma can occur in childhood and be able to send suspected patients to colleagues who could help in early diagnosis."

Experts widely praised the paper for providing some insight into what is a rare but increasing cancer and agreed that changes to screening recommendations were not necessary.

The U.S. Preventive Services Task Force guidelines currently say there is insufficient evidence to recommend for or against total body skin examinations, although the American Cancer Society recommends one every three years for those ages 20 to 39. Annual skin checks are recommended for those older than 40, but there are no specific recommendations for those younger than 20.