Dermatologist Sara Lamb provides an overview of childhood melanoma, the three classified categories of pediatric melanoma, different treatments and risk factors. Lamb explains some of the signs of childhood melanoma that pediatricians should look for.
Yeah, childhood melanoma refers to melanoma that develops before age 18 and thankfully, is extremely rare. The incident is about one per million in age 1 to 4 and jumps up to 10 per million in age 15 to 19. The majority of pediatric melanoma patients are non Hispanic Caucasians. Girls older than four have a higher incidence of lower body melanoma, and boys older than 10 have a higher incidence of head and neck melanoma. And although it's extremely rare, pediatric melanoma can be fatal and early diagnosis is key. Pediatric melanomas can be so classified into three main categories. Conventional melanoma, melanoma and melanoma arising in a congenital melon acidic Nevis and Spitzer had melanoma. Distinguishing between these three subtypes is important because each subtype has different treatment options, different risk factors and different histological findings. Pediatric conventional melanomas show characteristic UV damage and genetic similar to adult melanoma, so they have similar risk factors such as skin types, one and two history of blistering sunburns. And this can also be seen with certain immuno deficiencies or photo sensitizing disorders such as zero derma pigmentosa for subject to melanoma arising from congenital nev. I melanoma is most likely to develop in giant congenital knee vie with lifetime estimates between five and 10%. These occur in lesions, particularly that lie across the spine or where there are multiple satellite lesions adjacent to the giant General Nevis. Melanoma can also arise from euro melanocytes found in the brain and spinal cord or rarely in the GI tract. So Children with giant congenital never I need to be followed very closely. So the risk of melanoma was found to be 34 times higher in Children with over 100 moles and 15 times higher in Children with 10 or more large levi greater than five millimeters in diameter. And the third subtype of melanoma is schizoid melanoma, and it typically has a distinct clinical appearance with a starburst vascular pattern seen under Mosca P. The clinical progression of the schizoid lesions is different from typical melanoma because up to 39% of patients with schizoid um lesions can have nodal metastasis. However, unlike patients with typical melanoma, this note nodal disease does not have the same high mortality, and there's rarely any further disease progression. Mhm as an alternative to the A B. C. D. S, we learn um, and teach for adult melanoma with the asymmetry. Border irregularity. Color change diameter greater than six millimeters Childhood melanomas often don't meet these features and can be missed if we use this criteria. So, um, there has been developed a separate A B C D. Pneumonic for pediatric melanomas. A is for a melon arctic, so pediatric melanomas can often not have pigment and be skin toned or pink to red in color. B is for bleeding bump. So unlike the adult counterparts, pediatric melanomas often bleed. C is for color uniformity. So unlike the adult counterpart, where the melanomas have several different colors that can kind of tip us off. Pediatric melanoma, the colors usually uniform and D is for de novo any diameter, so it's typically a newly arising lesion, and it can be smaller than our six millimeter cut off. And finally ease for evolution to any lesion that's changing is something we want to keep an eye on. Yeah, treatment for childhood melanoma is very similar to the adult melanoma, and prognosis is based on the Breslow depth at the time of diagnosis and the presence of either nodal or distant metastases. Treatment can be targeted based on the immunological profile of the melanoma itself and certain mutations which we can check for. And survival rates are similar in older Children. Compared to adults, however, melanomas and Children under age 11 appeared to have a less aggressive behavior than those in adults. Yeah, mhm.