Melanoma is the least common type of skin cancer – it makes up only about 1% of all skin cancer diagnoses. But you may be surprised to learn that melanoma is the most common type of skin cancer among those with the shortest history of sun exposure: children. Eight percent of all cancers in children age 15 to 19 are melanomas.

Although it is very rare, melanoma can even be found in newborns and toddlers. But the disease becomes more common as children get older, especially among teenage girls. Research shows sun exposure and tanning bed use among teens has increased risk.

Other risk factors include:

• Fair skin
• A history of many blistering sunburns
• Several large or many small moles
• A family history of unusual moles
• A family history of melanoma

The good news is that when melanoma is diagnosed in children, it is highly treatable and actually has a better prognosis than the same stage of melanoma in adults. Parents need to be alert to any changes in their child’s skin. The ABCD rule used for evaluating moles on adults can also be used on children.

However, up to half of all pediatric melanomas may not follow these rules. Because of this, doctors suggest to also be aware of the following in children:

• A mole that changes or grows dramatically
• An odd-shaped or large mole
• A pale-colored or red bump that keeps growing
• Any mole or bump that bleeds

Dr. Vernon Sondak, chair of Moffitt Cancer Center’s Cutaneous Oncology Program, says there are two distinct forms of childhood melanoma – the rare type that arises from a mole present at birth and the more common sporadic form that occurs from sun exposure. However, children can also have atypical moles that can be very difficult to diagnose as either melanoma (cancerous) or benign. The Moffitt team, led by dermatopathologist Dr. Jane Messina, developed a 5-point scale to help classify the types of benign, atypical and cancerous moles that can occur in childhood, and to predict their associated risk.

“The system we have created has fostered better communication between the pathologists reviewing our biopsies and our surgeons and oncologists, which in turn has allowed us to better inform our pediatric patients and their families about their diagnosis and treatment plan,” said Sondak.

Treatment of melanoma in children is similar to adults. Surgery, chemotherapy, radiation therapy and immunotherapy are possible options depending on the stage of the disease. However, Sondak says while some therapies have great success in adults, those responses don’t always translate when the therapy is adapted for children. “There is a clear need for more prospective testing of therapeutic strategies in the pediatric population,” he added.

Moffitt’s Donald A. Adam Melanoma and Skin Cancer Center of Excellence is hoping to provide that much needed research. Its director, Dr. Keiran Smalley, was recently awarded $250,000 from the Live Like Bella Foundation to investigate the role of early childhood UV exposure on the development of melanoma and how this interacts with this immune system. In this study, we will also attempt to gain further understanding of the genetic underpinnings of pediatric melanoma.  “Once we have a clearer understanding of the biological events that can cause the disease to develop, we can find new tools to prevent and treat pediatric melanoma.”