Melanoma

What is melanoma?

Melanoma is the most serious form of skin cancer because it often spreads to other parts of the body. It begins in the melanocytes, which are skin cells that produce a pigment called melanin. Melanin is how your skin, hair and eyes get their color. 

Most melanomas begin in the skin, though they can also occur in the eye. Melanoma grows inward, into the skin. From there, it can affect blood vessels and the lymphatic system. The lymphatic system helps tissues and organs fight infections and get rid of toxins in the body. Once a melanoma reaches these systems, it can spread quickly to other organs in the body, such as the lungs or the brain.

Children with melanoma may have one of three different types:

• Conventional melanoma (CM), or “adult-type melanoma”: The most like adult melanoma in terms of its causes and risk factors 
• Spitzoid melanoma (SM): The most common type of melanoma in children. It often appears as a small collection of tissue that can be felt under the skin and is usually:
  • Round
  • Only one color
  • Found on the head, hands or legs
• Melanoma that arises in a large congenital melanocytic nevus (CNM): A large, pigmented mole or birthmark that is present at birth.

How common is melanoma in children?

While childhood melanoma is rare, it is the most common skin cancer in pediatric patients.

Less than 500 children are diagnosed with melanoma each year.

What are the signs of melanoma in children?

Signs of melanoma in children include changes in a mole’s size, shape, color and/or “feel.” Look for a mole that:

• Changes, grows quickly or doesn’t go away
• Is oddly-shaped or large
• Feels bumpy and sticks out from the skin around it
• Is whitish, yellowish or pink
• Is more than one color
• Itches or bleeds

Melanoma looks different and may grow faster in children than it does in adults. It often does NOT meet the guidelines – commonly referred to as ABCD (Asymmetry, Border irregularity, Color variability, and Diameter > 6 mm) – used to detect melanoma in adults.

What causes melanoma in children?

It is not known why children get melanoma early in life. Most adult melanomas can be linked to ultraviolet (UV) exposure from the sun’s rays. UV damage is most commonly seen in sunburns. Melanin can help protect the skin from this damage. 

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 chance of developing melanoma include:

• Fair skin, light hair and freckles
• Several large moles or many small moles
• A history of blistering sunburns or sunbathing
• A history of using tanning beds
• Exposure to X-rays
• A family history of melanoma

Certain genetic conditions (passed down in families) increase a child's risk of developing melanoma. These include:

• Xeroderma pigmentosum
• Werner syndrome
• A history of retinoblastoma
• Melanocytic nevi

How is melanoma treated?

• Surgery is used to diagnose and treat melanoma.  
  • A biopsy (removing a tissue sample to examine) is done to make the diagnosis. The doctor may need to see if the melanoma has spread to the lymph nodes, which are small structures that help the body filter out harmful substances. A biopsy of the lymph nodes is called a sentinel node biopsy.
  • If the tissue is found to be melanoma, the entire mole or affected area is removed.
  • If the cancer has spread, more surgery may be needed to remove as much of it as possible.

When possible, surgery is done to remove the melanoma and any affected lymph nodes. Some melanomas can be removed easily and need only minor surgery, while others may need a more extensive surgery.

Surgery is not an option for all children with melanoma. Instead, they may be treated with chemotherapy, immunotherapy or targeted therapy.

• Chemotherapy (“chemo”) uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells. Chemo is usually used if the disease has spread to the lymph nodes or to other organs.
  • 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.
• Radiation uses high-energy radiation to kill cancer cells. Radiation therapy is another treatment option if melanoma has spread.
• Immunotherapy activates the immune system and destroys the melanoma cells. Children 12 years or older with melanoma that cannot be removed by surgery or whose cancer has spread to other parts of the body are sometimes given an immunotherapy called Yervoy® (ipilimumab, pembrolizumab, nivolumab). Other immunotherapies can also be given directly into the tumor. 
• Targeted therapy uses medicines to attack a specific mutation (change) in the tumor. For example, medicines called BRAF and MEK inhibitors target cells with mutations in the BRAF gene. This mutation is found in about half of all melanomas.

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%.

The five-year survival rate is about 70% when melanoma has spread only to the lymph nodes.

If melanoma has spread beyond the lymph nodes to other parts of the body, the five-year survival rate is about 25% but these numbers have improved. Now about 50% of adult patients treated with combination immunotherapy are expected to be alive four years after diagnosis.

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.
• 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.
• We offer other modalities of therapy such as intralesional therapies and hyperthermic limb perfusion.