Melanoma

While the average age at diagnosis is 65, melanoma is actually the second most common cancer in teens and young adults between the ages of 15 to 29. And, though overall rates of pediatric melanoma have been decreasing, girls aged 15 to 19 account for the biggest increase in new melanoma diagnoses in recent decades (early 2000s onward). This is thought to be due to girls tanning more often than boys.

HN melanomas are more common in males. Girls are more likely to develop lower-body melanoma, especially in areas such as the legs. Due to heightened sun exposure in these areas, around 10% to 25% of all melanomas (both children and adults) develop in the highly visible and functionally important head and neck region, most commonly on the back of the scalp and the cheeks.

In younger patients, melanoma tends to be a confluence of risk factors – from genetics and family history to the presence of moles and UV exposure. In fact, less than a quarter of children with melanoma (22%) have “non-controllable” risk factors, such as genetic susceptibility. Most cases are related to UV light exposure, which increases the risk of pigment changes and skin cancers.

Traditionally, melanomas are associated with an asymmetrical appearance, irregular borders, color variations/diversity, a large diameter (more than six millimeters), and evolves in some way (such as sudden itching). To account for the unique presentation of pediatric melanoma, the ABCDEs have been updated for children as follows:

• Amelanotic – Lacking in color
• Bleeding – Or, maybe bumpy
• Color uniformity — Not multi-colored, as is the case with adult melanoma
• De novo/any diameter – Refers to new moles that can be of any width
• Evolving – Changes in size, shape, color, and feel (such as bleeding, itching, crusting, and pain)

While moles are typically harmless, more than 100 moles are associated with a 34 times greater risk of melanoma among adolescents aged 15 to 19. Additionally, melanoma arising from congenital moles (present at birth) is one of three main types of pediatric melanoma.

Sometimes, the first sign of a problem is enlarged lymph nodes in the neck. While rare, mucosal melanoma can also arise in the mucous membranes of the nasal cavity, mouth, and sinuses. This type of melanoma can present as discoloration in the mouth, ulcers, bleeding masses, frequent nosebleeds, and nasal obstruction. Since melanoma cells can spread through the blood and lymph nodes, it may be easier for these cancers to metastasize or grow beyond their original sites in the HN area, which may demand more aggressive treatment.

The phrase “a chance to cut is a chance to cure” largely applies here. While we must consider factors such as the location of the primary tumor and the progression of disease, surgical removal or excision is typically recommended. Traditionally, clinical trials for some treatments have excluded pediatric patients, or research has focused on adults. As with other pediatric and HN cancers, further research is necessary to determine effective medications and combination therapies.

The Pediatric Head and Neck Cancer Foundation is fighting this childhood cancer crisis by advancing research on diagnostic tools and treatments that account for the distinctive pathophysiology, anatomy, psychosocial, and other needs specific to pediatric populations. We are also proud to connect parents, caregivers, family members, and others with credible and trusted resources and support to navigate the challenges of a pediatric cancer diagnosis. To join this fight and to be a catalyst for real change, contact our team at pediatricheadneckcancer@gmail.com today.