As the warm weather approaches, my thoughts are turning happily toward
outdoor fun and other summer plans. But I’m also gearing up to see the one
sight at the beach that makes me cringe: a redheaded youngster, delightedly
constructing a sand castle under the blazing sun, with that telltale pink
creeping down her shoulders and back.
It’s not just that I know she may be in pain by the end of the day. It’s
that sunburn during childhood is one of the biggest risk factors for
developing skin cancer – and it’s preventable. Which brings me to a very
rare but potentially serious condition: pediatric melanoma.
Melanoma diagnosis is scary, and can be more complicated in kids because
the pediatric warning signs can be different from warning signs in adults.
But the good news is that, in addition to being rare – there are just 1.1
cases per million children under the age of 10 – pediatric melanoma is
usually preventable and treatable with early detection.
Of slightly more concern is teenage melanoma, which is already more common
than pediatric melanoma – 10 cases per million adolescents age 10 and older
– and is increasing about 2 percent each year. Among females ages 15 to 29,
melanoma is now the second most common cancer, according to the American
Academy of Dermatology. Some of that increase may be due to better
awareness and reporting, but much of it can be tied to the use of indoor
tanning booths, which use ultraviolet radiation (UV), a known carcinogen.
Whatever the age of your child, it’s important to be vigilant about skin
changes and to be smart about melanoma prevention.
The
ABCDE’s of detection
Melanoma is a form of skin cancer that occurs when the skin cells that
produce our skin’s color, called melanocytes, grow out of control. If
melanoma is diagnosed in its early stages, it can usually be treated fairly
easily by cutting it out. Melanoma’s scary reputation stems from what
happens when its early signs are missed or ignored, and it spreads to the
brain or other internal organs – that’s when it can become deadly.
Many of us are familiar with the adult warning signs of melanoma. ABCDE is a handy reminder to describe a mole that should
be checked by a board-certified dermatologist. Since teen melanoma is more
likely to follow the adult pattern, be sure to employ the ABCDE checklist
when monitoring your adolescent:
-
A
symmetrical shape -
B
order irregularity -
C
olor changes -
D
iameter bigger than a pencil eraser (larger than 6mm) -
E
volving over time
But for kids under 10, the signs don’t necessarily follow this pattern: the
first symptom could be as simple as a new pink bump. So, while you
definitely want to follow up on a skin lesion that has an irregular color
and changes over time, also know that any new bump – especially if it
bleeds or doesn’t go away after a few months – warrants a visit to the
pediatrician, who may follow up with a referral to a board-certified
dermatologist or, even better, a pediatric dermatologist.
Since melanoma in kids under 10 does not always meet the common criteria
for teens and adults, a new set of ABCD criteria has been proposed for
pediatric patients:
-
A for amelanosis (no dark color)
-
B for bumps or bleeding
-
C for color uniformity (versus color variability
in teens and adults) -
D for diameter variability or de novo
(new) development
While you should not hesitate to take action if your child exhibits a
concerning skin lesion, there is no need to panic: there are a variety of
relatively non-serious medical conditions – such as pyogenic granuloma (a
small, red, oozing and bleeding bump), molluscum contagiosum or warts (skin
infections caused by viruses) – that can appear as a new, growing bump.
Risk factors in children and teens
Certain factors place some kids at higher risk than others. Risk factors
include:
-
Fair skin, blue eyes and blond or red hair
-
Freckled or easily sunburned skin
-
Multiple abnormal moles, or a giant congenital mole on the body
-
A history of organ transplantation, certain genetic disorders (such
as xeroderma pigmentosum or albinism), or illnesses/medications
that can suppress the immune system -
A past blistering sunburn (even one during childhood or adolescence
can nearly double a person’s chance of developing melanoma) -
Close blood relative with history of melanoma (siblings or parents)
What you can do
Parents have more options than they may realize when it comes to protecting
their children from the potentially harmful effects of the sun and indoor
tanning booths. Consider the following precautions, and always speak with
your pediatrician or dermatologist about any concerns you may have:
-
When scheduling outdoor time, aim for earlier than 10 a.m. or later
than 2 p.m. to avoid the most potent sunrays. If your shadow is shorter than you are, seek shade. -
Think about sun protection with every outdoor activity –
not just the pool or the beach. Skin can burn while playing sports,
standing in line at the amusement park or waterpark or just playing
in the backyard. -
Dress your child in light, sun-protective clothing (long sleeves or
a rash guard and pants), a floppy hat that covers his or her ears
and UV-protection sunglasses. -
For children older than six months, use a broad-spectrum,
water-resistant sunscreen with an SPF of 30 or higher. Reapply
every 90 minutes to two hours. If you are concerned about certain
chemicals contained in some sunscreens, I recommend a sunblock with
zinc oxide or titanium dioxide instead. -
For infants under six months, sunscreen is not FDA-approved; babies
should wear a hat and stay in the shade of a tree or stroller
canopy. -
Use enough sunscreen. Adults must apply one ounce (the
equivalent of a shot glass) to the exposed areas of their bodies;
adjust this amount for your child’s size and apply 15 minutes
before going out. -
Eat a healthy diet that includes foods naturally rich in vitamin D
or take vitamin D supplements. You do not have to expose your child
to prolonged UV radiation from the sun in order to get adequate
vitamin D. -
If your teen must have a “tan,” I suggest sunless tanners, bronzer
lotions, makeup or spray-on tans. There are plenty of good ones
that won’t make them look orange and are healthier than exposure to
harmful radiation from a tanning booth. -
Many states already prohibit children under 18 from using indoor
tanning beds and others require parental permission. Check your
state’s requirements and talk to your teens about the dangers
involved. Help protect them by strongly discouraging indoor
tanning. -
Do regular body and scalp checks looking for new or changing
bumps/moles.
Parents are a major influence on their children when it comes to sun
safety, and whether that’s a plus or a minus depends on the situation. When
parents tan, kids will often follow in their footsteps; it’s hard to tell
your child “no” when you’re doing it yourself, and parents are more likely
to sign their kids in at the salon when they’re regulars, too. But on the
flip side, when parents establish melanoma-preventive habits early on, kids
tend to carry on the tradition, whether that means using sunblock, covering
up with sun-protective clothing or avoiding prolonged time in the sun
altogether.
The bottom line is that you can have fun in the sun and maintain a healthy
appearance, while still being smart. By starting healthy skin care habits
early with your children, you can help prevent skin cancer all the way
through the teenage and adult years.
For guidelines to prevent skin cancer, visit cdc.gov.
For a powerful 60-second video produced by the American Academy of
Dermatology, which warns young women that tanning – indoors or out – can
have scary consequences in the future, watch “Arms.”
youtube.com/watch?v=usA70a5opug
