Skin Cancer in Children

What is skin cancer?

Skin cancer is a malignant tumor that grows in the skin cells. In the US alone, more than 1 million Americans will be diagnosed in 2009 with nonmelanoma skin cancer, and 68,720 will be diagnosed with melanoma, according to the American Cancer Society.

Fortunately, skin cancers (basal cell and squamous cell carcinoma, and malignant melanoma) are rare in children. When melanomas occur, they usually arise from pigmented nevi (moles) that are large (diameter greater than 6 mm), asymmetric, with irregular borders and coloration. Bleeding, itching, and a lump under the skin are other signs of cancerous change. If a child has had radiation treatment for cancer, nevi in the radiated area are at increased risk of becoming cancerous.

What causes skin cancer?

Exposure to sunlight is the major contributing factor to developing skin cancer later in life. In particular, blistering sunburns in childhood and adolescence significantly increase the risk of developing malignant melanoma.

Most people receive more than 50 percent of their lifetime ultraviolet (UV) dose by 20 years of age. Limiting exposure to sunlight in children and teens may pay large dividends in preventing cancers later in life.

What are the different types of skin cancer?

There are three main types of skin cancer, including:

Name

Description

basal cell carcinoma

Basal cell carcinoma accounts for approximately 80 percent of all skin cancers. This highly treatable cancer starts in the basal cell layer of the epidermis (the top layer of skin) and grows very slowly. Basal cell carcinoma usually appears as a small, shiny bump or nodule on the skin - mainly those areas exposed to the sun, such as the head, neck, arms, hands, and face. It commonly occurs among persons with light-colored eyes, hair, and complexion.

squamous cell carcinoma

Squamous cell carcinoma, although more aggressive than basal cell carcinoma, is highly treatable. It accounts for about 20 percent of all skin cancers. Squamous cell carcinoma may appear as nodules or red, scaly patches of skin, and may be found on the face, ears, lips, and mouth. Squamous cell carcinoma can spread to other parts of the body. This type of skin cancer is usually found in fair-skinned people.

malignant melanoma

Malignant melanoma accounts for a small percentage of all skin cancers, but accounts for most deaths from skin cancer. Malignant melanoma starts in the melanocytes cells that produce pigment in the skin. Malignant melanoma usually begins as a mole that then turns cancerous. This cancer may spread quickly. Malignant melanoma most often appears on fair-skinned men and women, but persons with all skin types may be affected.

Distinguishing benign moles from melanoma:

To prevent melanoma, it is important to examine your child's skin on a regular basis, and become familiar with moles, and other skin conditions, in order to better identify changes. According to recent research, certain moles are at higher risk for changing into malignant melanoma. Moles that are present at birth and atypical moles, have a greater chance of becoming malignant. Recognizing changes in your child's moles, by following this ABCD Chart, is crucial in detecting malignant melanoma at its earliest stage. The warning signs are:

Normal Mole / Melanoma

Sign

Characteristic

Photo comparing normal and melanoma moles showing asymmetry

Asymmetry

when half of the mole does not match the other half

Photo comparing normal and melanoma moles showing border irregularity

Border

when the border (edges) of the mole are ragged or irregular

Photo comparing normal and melanoma moles showing color

Color

when the color of the mole varies throughout

Photo comparing normal and melanoma moles showing diameter

Diameter

if the mole's diameter is larger than a pencil's eraser

Photographs Used By Permission: National Cancer Institute

Melanomas vary greatly in appearance. Some melanomas may show all of the ABCD characteristics, while other may only show changes in one or two characteristics. Always consult your child's physician for a diagnosis.

What are the risk factors for melanoma?

Skin cancer is more common in fair-skinned people - especially those with blond or red hair, who have light-colored eyes. Skin cancer is rare in children. However, no one is safe from skin cancer. Other risk factors include:

  • family history of melanoma

  • sun exposure

    The amount of time spent unprotected in the sun directly affects your child's risk of skin cancer.

  • early childhood sunburns

    Research has shown that sunburns early in life increase a child's risk for skin cancer later in life. Sun exposure early in life is the major contributing factor to developing skin cancer.

  • many freckles

  • many ordinary moles (more than 50)

  • dysplastic nevi

Prevention of skin cancer:

The American Academy of Dermatology (AAD) has declared war on skin cancer by recommending these three preventive steps:

  • Wear protective clothing, including a hat with a four-inch brim and sunglasses.

  • Apply sunscreen all over your child's body and avoid the midday sun from 10 a.m. to 4 p.m. (Keep infants under 6 months of age out of direct sunlight at all times.)

  • Regularly use a broad-spectrum sunscreen with an SPF of 15 or higher, even on cloudy days.

The following steps have been recommended by the AAD and the Skin Cancer Foundation to help reduce the risk of sunburn and skin cancer.

  1. Minimize exposure to the sun at midday - between the hours of 10 a.m. and 4 p.m.

  2. Apply sunscreen, with at least a SPF-15 or higher that protects against both UVA and UVB rays, to all areas of your child's (older than 6 months of age) body that are exposed to the sun.

  3. Reapply sunscreen every two hours, even on cloudy days. Reapply after swimming or perspiring.

  4. Use extra caution near water, snow, and sand - they reflect the damaging rays of the sun, which can increase the chance of sunburn.

  5. Make sure your child wears clothing that covers the body and shades the face. Hats should provide shade for both the face and back of the neck. Wearing sunglasses will reduce the amount of rays reaching the eye by filtering as much as 80 percent of the rays, and protecting the lids of the eyes, as well as the lens.

  6. Avoid exposure to UV radiation from sunlamps or tanning parlors.

  7. Protect children from excessive sun exposure when the sun is strongest (between 10 a.m. and 4 p.m.) by having them play in the shade, wear protective clothing, and use sunscreen liberally and frequently - for children 6 months of age and older.

  8. Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't seek the sun.

The American Academy of Pediatrics (AAP) approves of the use of sunscreen on infants younger than 6 months old if adequate clothing and shade are not available. Parents should still try to avoid sun exposure and dress the infant in lightweight clothing that covers most surface areas of skin. However, parents also may apply a minimal amount of sunscreen to the infant's face and back of the hands.

Remember, sand and pavement reflect UV rays even under the umbrella. Snow is a particularly good reflector of UV rays. Reflective surfaces can reflect up to 85 percent of the damaging sun rays.

How to perform a skin examination:

Finding suspicious moles or skin cancer early is the key to treating skin cancer successfully. Examining your children (and yourself) is usually the first step in detecting skin cancer. The following suggested method of examination comes from the American Cancer Society:

  • Examine your child's body front and back, then the right and left sides, with arms raised.

  • Look carefully at your child's forearms, the back of his/her upper arms, and the palms of the hands. Check between the fingers and look at the nail beds.

  • Look at backs of his/her legs and feet, spaces between the toes, the toenail beds, and the soles of the feet.

  • Examine the back of his/her neck and scalp.

  • Check his/her back, buttocks, and genital area.

  • Become familiar with your child's skin and the pattern of moles, freckles, and other marks.

  • Be alert to changes in the number, size, shape, and color of pigmented areas.

  • Follow the ABCD Chart when examining moles of other pigmented areas and consult your child's physician promptly if you notice any changes.

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