Melanoma in Children Rare, But Possible

Parents, Physicians Need to be Aware of Skin Changes

When Claire Brousseau noticed a tiny scratch on her 19-month-old daughter Meagan's chin, she thought it was a typical toddler boo-boo.

Two weeks later, the scratch looked like a harmless, little pimple, but then it began to grow.

Because it was increasing in size, Meagan's pediatrician recommended she see a dermatologist. The dermatologist said not to worry because it was a benign condition called pyogenic granuloma. This fast-growing, relatively common nodule appears in children when blood vessels grow too rapidly.

But then the bump grew to the size of a marble in less than a month, and Brousseau took Meagan to a plastic surgeon, who removed the growth and sent it to a lab. The specimen was forwarded to M. D. Anderson, where pathologists diagnosed melanoma, the most potentially lethal form of skin cancer.

Melanoma is uncommon in young children

Meagan's melanoma is one of the rarest ever treated at the cancer center, says her oncologist Cynthia Herzog, M.D., an associate professor in M. D. Anderson's Department of Pediatrics who specializes in melanoma.

"The disease is rare for adolescents and even more rare for very young children," adds Madeleine Duvic, M.D., professor and director ad interim of M. D. Anderson's Department of Dermatology and associate medical director of the institution's Melanoma & Skin Center.

Melanoma can occur at any age, Duvic says, but it is usually diagnosed in a person's 20s to 40s. About 100 melanoma patients, age 2 to 19, have been treated at M. D. Anderson since 1992, with the majority between the ages of 14 and 19, Herzog says.

National statistics say melanoma found between ages:

• 14 and 19 occurs in 1.3 persons per 100,000
• 10 and 14 occurs in 0.3 persons per 100,000

No data is available for children younger than 10 because melanoma occurs so infrequently at that age, thus making cancer studies virtually impossible, Herzog says.

Melanoma in adults is attributed mainly to sun exposure that could have taken decades to develop. The cause of melanoma in young children is not known, Herzog says.

Increase in youth melanoma cases is not clear

Since 1981, melanoma has continued to rise at a rate of 3% per year, says the American Cancer Society (ACS). Recent news stories also have reported an increase in melanoma in adolescents and children, but Herzog questions the increase, especially at M. D. Anderson.

"There's a feeling that there's an increase, but we don't know that it's real," Herzog explains. "It could be that we are just getting more referrals because we specialize in treating young melanoma patients or that we have more patients following the onset, in 1992, of lymph node mapping (a key part of melanoma treatment)."

The message for parents is to not panic, Herzog says, but be aware of odd-looking moles (especially large ones) - no matter what the child's age - and take action.

Melanoma can be caught early if parents:

• Watch moles closely
• Take a child to a dermatologist who will:
• • Take photos of the child's skin
  • Measure moles
  • Keep a record of mole growth
• Have growths and moles removed if they are changing
• Make sure the growth is sent to a lab for analysis
• Get a referral to an oncologist who treats melanoma if:
• • Melanoma is diagnosed
  • Results are inconclusive (not sure if it is melanoma)

"Melanoma is a surgical disease, and as long as surgeons remove it early on, it's treatable," Herzog says. "If it were my child, the safest thing would be to have surgery."

Young patients are monitored as they grow up

There are about 50 former patients, 18 years old and younger, who are currently being monitored by M. D. Anderson physicians and surgeons for skin changes, and another 10 to 15 patients who are older than 18 but were diagnosed when they were younger than 18, Herzog says.

Duvic currently follows the moles of five former melanoma patients diagnosed before the age of 19.

Of that group, one young man who was treated at age 9 has since had five melanomas removed. An 18-year-old, who had her first melanoma at 12, hasn't had any since.

Life goes on for young, former melanoma patients

"The kids I take care of now are teenagers or in college, and they've been fine," Duvic says.

So is Meagan, now 5, although she and her family have undergone an extremely difficult period. The last three years have included seven surgeries - to completely remove tumor traces and several lymph nodes - plus reconstructive plastic surgery. Meagan also has had severe treatment side effects including pancreatitis, seizures and drug-induced psychosis, Brousseau says.

Today, fortunately, Meagan feels well and is cancer-free. She thinks nothing of the daily "lumps and bumps" check her mom conducts and the regular visits to the dermatologist to monitor moles. She's just herself, Brousseau says, a happy, active child ready to take on the world.