Disease Information

Solid Tumor: Melanoma

Alternate Names: None

Definition

• Melanoma is the most common skin cancer in children.
• Melanoma can appear on the skin in any part of the body and may or may not develop from a pre-existing mole.
• Warning signs that a skin lesion may be a melanoma include changes in color or contains various color hues (brown, tan, pink, black), increase in size, irregular shape/border, pain, bleeding or itching.
• Melanoma may spread to other parts of the body, including the lymph nodes, brain, liver, lung and bones.

Incidence

• Of the estimated 55,000 cases of melanoma diagnosed in the United States each year, fewer than 5 percent occur in patients under the age of 20 and only 0.3 percent among those younger than 14 years.
• Melanoma accounts for only 1-2 percent of all pediatric cancers.

Influencing Factors

• Melanomas may be congenital (present at birth). They are sometimes associated with large congenital black spots known as melanocytic nevi, which may occur on any part of the body.
• Children with dysplastic nevus syndrome, giant congenital nevi, DNA repair disorders (i.e., xeroderma pigmentosum, ataxia-telangectasia, Bloom's syndrome) or immunodeficiency states have an increased risk of developing melanoma.
• The most common cause of skin cancer is exposure to the ultraviolet (UV) portion of sunlight. The person who is most likely to develop a melanoma is easily sunburned, has poor tanning ability and generally has light hair, blue eyes and pale skin.
• Other causes include exposure to cancer-causing chemicals and ionizing radiation.
• Individuals who have a family member with melanoma are at increased risk of melanoma.

Survival Rates

• Thickness of a tumor, as measured by a pathologist, has been shown to predict the likelihood of tumor spread (metastases) or recurrence.
• Prognosis for superficial melanomas that can be completed resected is excellent with approximately 90 percent of patients surviving 10 years from diagnosis.
• Survival is decreased if the melanoma has spread to distant organs.

Treatment Strategies

• The best treatment for melanoma is complete removal by surgery. Surgery for melanoma depends on the size, site, level of invasion into the skin and stage of the tumor. Because melanoma has a high likelihood of spreading to other parts of the body, a sentinel lymph node biopsy is often performed as part of the surgery. This procedure helps identify where the cancer cells are most likely to spread first and predict who will need treatment other than surgery.
• The most effective drugs include alpha-interferon and dacarbazine. Unfortunately, these agents are rarely effective for patients whose tumors are not removable by surgery.

Current Research

• Malignant melanoma is rare in children, and scientists are still searching for the optimal therapy. Most currently available data about treatment for pediatric melanoma has been derived from adult studies.
• An ongoing treatment protocol (MEL06) at St. Jude is designed to test a new formulation of interferon, pegylated alpha-interferon, in patients with high risk disease.

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