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“Pediatric melanoma is still uncom-mon in children,” notes Dr. Elizabeth Hamilton of Regional

Dermatology of Durham, “but in my early practice days, more than 20 years ago, it was very rare.

“Now we are nationally experiencing as many as 500-plus cases each year. The Skin Cancer Foundation reports that overall, pediatric melanoma, while still uncommon, increased by an average of two percent per year in the most recent decade.

“Melanoma in children can be difficult to diagnose,” she notes. “Since it is rare, the index of suspicion tends to be low. So on a statistical basis, the likelihood of a lesion being melanoma in a young child is small. Secondly, biopsing a spot on a young child can be a challenge. A simple procedure on an adult can be an ordeal for a child. Some-times a child will have to be put to sleep for a biopsy. This requires referral, another visit for the parent and patient, and then the procedure. In other words, it is a hassle and while we would always rather be safe that sorry, it is not always easy to achieve.

“Lastly, melanomas in young children do not always have the usual characteristics of a melanoma. Melanomas in children before puberty are more likely to lack color and may even resemble warts, which are very common in children.

“As a child ages into adolescence and puberty,” Dr. Hamilton notes, “the conven-tional rules of melanoma detection (A-B-C-D: Asymmetry, Border irregularity, Color variegation, Diameter > 6mm or Dark) tend to be helpful. But for all ages, the most im-portant characteristic is E for Evolution or change. Change in a spot is the single most common trait of a melanoma.”

The risk factors for melanoma in children depend on the age, Dr. Hamilton explains. “Before the age of 10, the vast ma-jority of children who develop melanoma do not have obvious risk factors. Those that do have either a large birth mole, a past history of cancer or other condition that compromised their immune system.

“Over the age of 10, the risk factors for melanoma resemble those of adults. Those are fair skin type, history of multiple blister-ing sunburns, family history of melanoma, and lots of moles—usually more than 50.”

Health&Healing: The drumbeat about protecting ourselves from the sun’s rays continues.

DR. haMiltOn: The one risk factor that we can control is sun exposure and sun burns. The Skin Cancer Foundation also tells us that sustaining five or more sunburns in the youthful years increases lifetime mela-noma risk by 80 percent. It’s worth noting that of the seven most common cancers in the U.S., melanoma—the most deadly form of skin cancer—is the only one whose incidence is increasing. Between 2000 and 2009, the incidence of melanoma climbed by two percent annually.

And so we repeat to parents, again and

again, that it is essential to protect children from excessive exposure to the sun. Chil-dren’s skin is much more fragile than the skin of adults, and thus much more susceptible to damage from UV rays. We also emphasize sun protection for children because this is when they will develop good habits.

The guidelines for older children are similar to those for adults: avoid unprotect-ed exposure during the peak sun hours; seek shade; wear sun-protective clothing—big brim hats, sun glasses, shirts—and use sun-screen that is broad spectrum and greater than SPF 30.

For infants, sun avoidance is recom-mended. They should be out of the sun or covered up. Toddlers get a little more chal-lenging. I emphasize sun-protective cloth-ing, avoiding the mid-day sun, and favor sun block (chemical free) creams. Parents like the convenience of sprays but recently there has been concern of inhaled products. It is now recommended that sprays be ap-plied with the hands or closely onto the skin so that little product is airborne.

I continue to advocate for balance. Arrange protected playtime for kids in the safer parts of the day—early to mid-morning, and mid-afternoon into the early evening. Simply stay out of the hot blister-ing mid-day sun when the most damage can be done, even when you feel well protected from UV rays.

Health&Healing: Do you believe it’s wise for parents to have moles, rashes, and skin irregularities in their children checked by a dermatologist?

DR. haMiltOn: In general, I think pe-diatricians often treat rashes effectively and that’s fine as long as the condition is improving. Most pediatricians are quick to refer a rash that is not getting better or to evaluate a mole, birthmark, and other skin conditions beyond the typical bumps, bruises, and classic problems such as poison ivy. They also do a pretty good job of knowing when to refer to a pediatric dermatologist or a general dermatologist.

H&H: There are, we suspect, skin conditions that are more common to young people.

DR. haMiltOn: Yes. Examples would include keratosis pilaris and pityriasis alba—both quite common. Keratosis pi-laris, which is not uncommon in adults, is the result of skin cells collecting at the up-per opening of hair follicles, resulting in an inherited condition. The plugs cause small, pointed bumps to occur, most commonly on the upper arms, thighs, buttocks, and cheeks of the face. The skin has a rough texture.

On the face, keratosis pilaris is often mistaken for acne, and we see some young adolescents with both. As the acne becomes fully developed, the keratosis pilaris simply goes away. In infancy, some people call keratosis pilaris “milk bumps”—little white

bumps on the side of the face, similar to the little rough bumps around hair follicles on the back of the arms.

The condition is harmless, and tends to improve with age. Treatment with moistur-izers and some prescription medications is helpful.

H&H: And pityriasis alba?

DR. haMiltOn: This is relevant, especially during swim season. Pityriasis alba is a mild form of eczema where the loss of color is more visible than redness. In dark skin it can be very dramatic—in children and less often in adults—because it causes highly visible light spots, much like light finger-prints on the face. Sometimes it becomes so generalized that there are big, round patches where the skin is much lighter than the normal skin color—with a bit of scaling, but not a great deal. Sun exposure tends to make it more apparent as the affected areas do not tan.

Too often, pityriasis alba is confused with other skin conditions and is improp-erly treated with anti-fungal agents without success. The condition has nothing to do with fungus. For treatment, we recommend gentle skin care and prescribe a mild topi-cal steroid and as always sun protection to minimize the cosmetic impact. h&h

r E G i o n a l D E r M a t o l o G Y o f D u r H a M , p l l C

Dr. Hamilton offers a young patient advice about skin care and protection.

Pediatric Melanoma: Rare, But on the Rise“Pediatric melanoma increased by an average of two percent per year in the most recent decade.”

for more information about skin conditions and treatment, contact:

REGIONAL DERMATOLOGY OF DURHAM, PLLC

Elizabeth H. Hamilton, MD, PhD Amy Stein, MD

Julie Dodge, PA-C ���� Medical park Drive, Suite �0�

Durham, nC �770�telephone: (9�9) ��0-75�� (Skin)

www.dermatologydurham.com

Originally published in Health & Healing in the Triangle, Vol. 17, no. 5, health & healing, inc., Chapel hill, nC, publishers. Reprinted with permission.