Pediatric Melanoma

What is melanoma?

• Melanoma is a type of skin cancer that arises from a type of cell called melanocytes. These cells make a pigment called melanin that gives skin its color. Melanoma is most commonly caused by exposure to ultraviolet radiation (UV) from sunlight. There are certain conditions or activities that can increase the risk of melanoma, including very fair skin, frequent sunburns or tanning bed use, large black spots on the skin called melanocytic nevi and some types of moles.

What are the symptoms of melanoma?

• Melanoma usually presents as an unusual appearing mole. Some of the criteria used to distinguish normal moles from possibly cancerous moles are:
  • Asymmetry – the mole is unusually shaped and not symmetric
  • Border – the edges of the mole are jagged or irregular
  • Color – the mole has uneven shades of black, black/blue or brown coloring
  • Diameter – the mole is increasing in size or is larger than a pencil eraser
  • Evolving – the mole is changing over the course of several weeks
• Other concerning signs or a mole that changes quickly, itches or bleeds. If there are any concerning moles on your child, they should be examined by a dermatologist.

How common is melanoma?

• Overall, melanoma is rare in children. When it occurs in children, it usually occurs in older children and teenagers. About 7% of all cancers diagnosed in teenagers are melanoma.

How is melanoma diagnosed?

Depending on the type and site of the tumor, a variety of techniques may be used to diagnose and stage melanoma. These include:

• Biopsy, in which a pediatric surgeon or dermatologist performs a procedure to take a sample of the mole in order to determine what type of tissue it is and to run special molecular tests. If it is suspected to be melanoma, the entire affected area may be removed.
• Sentinel node biopsy, in which dye is injected into the mole, then the lymph nodes in the area are biopsied in order to determine if the cancer has spread to the lymph nodes
• Positron emission tomography (PET) scan, which uses radioactive sugar injected into a vein, is sometimes used to determine if the tumor has spread to other areas of the body

How is melanoma staged?

The staging for melanoma is based on the “TNM” staging system, which stands for “Tumor, nodes and metastasis”. The staging system can be somewhat complex and is explained in detail here.

• The T category is based on the thickness of the melanoma and other key factors seen in the skin biopsy.
  • Tumor thickness: The thickness of the melanoma under the microscope is measured. This is called the Breslow measurement. As the melanoma becomes thicker, it has a greater chance of spreading.
  • Mitotic rate: To measure the mitotic rate, the pathologist counts the number of cells in the process of dividing (mitosis) in a certain amount of melanoma tissue. A higher mitotic rate (having more cells that are dividing) means that the cancer is more likely to grow and spread.
  • Ulceration: Ulceration is a breakdown of the skin over the melanoma. Melanomas that are ulcerated tend to have a worse prognosis.
• The N category is based on whether lymph nodes are involved, as determined by sentinel lymph node biopsy or PET scan
• The M category is based on whether there is spread to any distant areas of the body outside of regional lymph nodes
• Once the T, N, and M groups have been determined, they are combined to give an overall stage, using Roman numerals I to IV (1 to 4) and sometimes subdivided using capital letters. This process is called stage grouping. In general, patients with lower stage cancers have a better outlook for a cure or long-term survival.

How is melanoma treated?

• Treatment for melanoma may involve a combination of therapies including surgery, chemotherapy, immunotherapy or targeted therapy. Treatment options may vary greatly, depending on your child's situation. Our pediatric oncologists work closely with a multidisciplinary team to create a personalized treatment plan that is best for your child.

Surgery

• Surgery is usually the first step in treating children with melanoma. In some cases, only a biopsy is done. If this is the case, as second surgery will usually be done to completely remove the tumor. In other cases, the tumor can be removed completely in the initial surgery. A sentinel lymph node biopsy is often done as well to determine if the tumor has spread to the lymph nodes.

Chemotherapy

• In cases where the tumor is not completely removed or if it has spread to other areas of the body, chemotherapy may be given.

Immunotherapy

• Newer immunomodulating agents now available may be used to help activate the immune system to help destroy the tumor.

Targeted therapy

• Newer medicines are now available that target and attack specific cancer cells without harming normal cells. Many of these medicines are still considered experimental.

What clinical trials does Ochsner Children’s Hospital offer for melanoma?

• As part of the Children’s Oncology Group, Ochsner Children’s Hospital is an active participant in children’s cancer research. We currently have multiple clinical trials available to treat children and young adults with various types of melanoma.

Active clinical trials for melanoma at Ochsner Children’s