What is melanoma?
Melanoma is the most serious form of skin cancer because it often spreads to other parts of the body. Melanoma gets its name from melanocytes—skin cells that produce a pigment called melanin, which gives skin its color.
The most common cause of melanoma is exposure to ultraviolet (UV) radiation from the sun’s rays. Melanin helps protect the skin from UV damage, such as sunburn, depending on the amount in a person’s skin:
- People with more melanin and darker skin are less likely to develop melanoma.
- People who tan poorly and sunburn easily—such as those with fair skin, light hair and blue eyes—have less melanin and are more likely to develop melanoma.
Other factors that may increase the likelihood of developing melanoma include the following:
- Certain conditions present at birth, such as large black spots called melanocytic nevi
- Some types of moles (melanoma may or may not develop from a pre-existing mole)
- Lengthy periods of sun exposure, such as repeated sunbathing
- Exposure to X-rays and cancer-causing chemicals
- Use of tanning booths
- Severe sunburns in childhood
- Genetic conditions (passed down in families) such as xeroderma pigmentosum and Werner syndrome
How common is melanoma?
- Melanoma is the least common skin cancer overall. About 76,700 new cases are diagnosed in the United States each year.
- However, melanoma is the most common skin cancer in children. About 7 percent of cancers in children 15 to 19 years of age are melanomas. This disease is very rare in younger patients. Melanoma is most common in people of Caucasian descent, occurring five times more often than in Hispanics and 20 times more often than in African Americans.
- The good news is that melanoma is commonly diagnosed at an early stage, when only the top skin layer is affected. Each year, the National Cancer Institute estimates that 48,000 of those diagnosed with melanoma have this early and highly treatable form of the disease.
What are the symptoms of melanoma?
Melanoma skin changes include the size, shape, color and/or “feel” of a mole. “ABCDE” is used to diagnose melanoma in adults:
- Asymmetry—the shape of one half of the mole is different from the other half
- Border—the edges are ragged, blurred, irregular
- Color—uneven and including shades of black, blue-black, brown or tan
- Diameter—changes in the size of the mole, usually an increase
- Evolving—changes in the mole over a few weeks or months
But childhood melanoma might not fit into those categories. Look for the following:
- A mole that changes, grows or doesn’t go away
- An odd-shaped or large mole
- A pale-colored or red bump
- A mole or bump that itches or bleeds
How is melanoma treated?
- Surgery — is used for diagnosing melanoma and, usually, for treating it:
- A biopsy (removing a tissue sample to examine) is done to make the diagnosis.
- If the biopsied tissue is melanoma, the entire mole or affected area is removed.
- If the cancer spreads, more surgery may be needed to remove as much of it as possible.
- A sentinel node biopsy may be used to look for involved lymph nodes.
Sometimes surgery is not an option. Instead, the patient may be treated with chemotherapy, immunotherapy or targeted therapies.
- Chemotherapy (“chemo”) — uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells:
- Chemo may be injected into the bloodstream, so that it can travel throughout the body.
- Some chemo may be given by mouth.
- Combination therapy uses more than one type of chemo at a time.
- Immunotherapy — activates the immune system and destroys the melanoma cells.
- Targeted therapy — uses drugs that attack a specific mutation (change) in the tumor.
What are the survival rates for melanoma?
- When melanoma is found and treated early, it is highly curable, with a five-year survival rate of more than 90 percent.
- If the cancer has spread by the time melanoma is found:
- The five-year survival rate is about 60 percent when melanoma has spread only to the lymph nodes, which are small structures that help the body filter out harmful substances.
- If melanoma has spread beyond the lymph nodes to other parts of the body, the five-year survival rate is lower than 20 percent.
Why choose St. Jude for your child’s melanoma treatment?
- St. Jude is the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children.
- St. Jude has created more clinical trials for cancer than any other children’s hospital in the United States.
- The nurse-to-patient ratio at St. Jude is unmatched— averaging 1:3 in hematology and oncology, and 1:1 in the Intensive Care Unit.
- St. Jude offers a dedicated team of specialists to meet the needs of children with melanoma, including: surgeons; doctors and nurses who treat this cancer; doctors who specialize in diagnosis (pathologists); dietitians; child life specialists; psychologists; Quality of Life team members; researchers; scientists; and many others.
- Complete, quality surgery is an important part of treating melanoma. The expert skills and experience of St. Jude specialty surgeons can help improve patients’ chances for best outcomes.
- Expertise in surgery: We were one of the first centers to use sentinel node biopsy for melanoma more than 20 years ago.
- Malignant melanoma is rare in children, and our center has been involved in researching this disease for more than 20 years. Using next-generation whole genome sequencing, scientists involved with the St. Jude Children’s Research Hospital –Washington University Pediatric Cancer Genome Project have characterized the genetic changes of various types of melanoma in children. Researchers hope this project will lay the foundation for improving diagnostic testing as well as developing more effective melanoma therapies.
- We offer imaging with PET (positron emission tomography) and lymphoscintigraphy (used to map sentinel lymph nodes, which are the first nodes to receive lymph from a tumor).
- A recently completed clinical trial at St. Jude was the first study to use a medicine called pegylated alpha-interferon in children with high-risk melanoma.
- One ongoing St. Jude clinical trial involves an antibody called GD2 that seeks out and destroys specific cancer cells. This trial is open to patients with recurrent neuroblastoma, osteosarcoma or melanoma.
- Another study is offered to certain melanoma patients who have a mutation (genetic change) in the BRAF gene. A new medicine has been designed to target the BRAF mutation, which is involved in about half of all melanomas.
- A third trial is studying a drug called ipilimumab, which enables the child’s immune system to attack the melanoma.
Associated Clinical Trials
BRF116: A Study to Determine Safety, Tolerability and Pharmacokinetics of Oral Dabrafenib In Children and Adolescent Subjects
Phase I/IIa, 2-Part, Multi-Center, Single-Arm, Open-Label Study to Determine the Safety, Tolerability and Pharmacokinetics of Oral Dabrafenib in Children and Adolescent Subjects with Advance BRAF V600-Mutation Positive Solid Tumors
- Participant is greater or equal to 12 months and less than 18 years at the time of signing the informed consent form.
- Participant has BRAF V600 mutation positive tumor as confirmed in a CLIA-approved laboratory or equivalent
- Participant has recurrent disease, refractory disease, or progressive disease after having received at least one standard therapy for their disease, OR participant has metastatic (or surgically unresectable) melanoma, and is being enrolled for first-line treatment. Melanoma participants with CNS involvement may be enrolled.
Molecular Analysis of Childhood and Adolescent Melanocytic Lesions
- Diagnosed with a melanoma tumor that is malignant (cancerous) or that might be cancerous, including:
- Conventional or “adult-type” melanoma
- Spitzoid melanoma/atypical Spitz tumor
- Congenital melanoma
- Melanoma arising in a giant congenital nevus
- Melanocytic lesions with indeterminate biological behavior (e.g., pigment-synthesizing melanomas)
- Younger than 19 years of age
A Phase I/II Study of Pembrolizumab (MK-3475) in Children with Advanced Melanoma or a PD-L1 Positive Advanced Relapsed or Refractory Solid Tumor or Lymphoma (Merck study KEYNOTE-051, IND# 110,080, dated 10-15/2014). EudraCT NUMBER: 2014-002950-38
- Between 6 months and 18 years old with diagnosis of advanced melanoma or PD-L1 positive advanced, relapsed or refractory solid tumor or lymphoma, or MSI-H solid tumor
- Between 3 and 18 years of age with relapsed or refractory classical Hodgkin lymphoma
- Negative pregnancy test 72 hours prior to medication administration in participants of child-bearing potential
- Appropriate liver and kidney functions
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