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Moles and Melanoma

Although childhood malignant melanomas are rare, physicians and parents must keep an eye out for them.  About 2% of all melanomas appear in children, but the types that commonly oc­cur in children are different from those found in adults. Melanomas in children arise from three things: 1. congenital nevi (moles that are there at birth),  2. de novo nodu­lar nevi (moles that come up new as they grow older), and 3. superficial spreading melanomas that are sun induced from moles that have been there for years.


Although 70% of melanomas in adults are sun induced and are superficial spreading melanomas, about 80% in children arise from congenital moles or de novo nodular lesions. There are very dif­ferent concepts of melanoma in child­hood.


1. Congenital moles that occur in 2% of children arise during the first 4 months of life. Most are small, less than 1.5 cm.  Excision of congenital moles is not nec­essary in infancy.  It is suggested that children with these moles be followed close­ly by parents and physicians. In children, these are more important than the other moles.  Melanomas in small congenital moles usually occur at or after puberty so they should be removed before puberty, espe­cially if the mole is on the scalp, face, or trunk.  Giant moles in children and those over 6 cm in a newborn, have a 5%-8% chance of melanoma risk. Many of these nevi are too large to totally excise.


2. The second most common type in chil­dren is nodular melanoma, constituting 40% of the melanomas in childhood. The nodules are rapidly growing and a red, bluish purple in color. They often ulcerate and, at times, bleed.  This is a highly fatal type.  The nodules are thick at the time of diagnosis.


3. And, in third place are the superficial spreading malignant melanomas. Here the ABCD rule applies: asymmetry, border irregularity, color variation, and diameter over 6 mm. However, the idea that the le­sion in a child has to be more than 6 mm is not reality.  This type is increasing because of the sun exposure of kids.


In adults, melanomas start out as a speck, and only 20%-40% start in preexisting moles. About 60%-80% start in de novo moles (new moles that are just beginning).  It's the new kid on the block, the new mole that can get you into trouble.  All moles have some potential to develop melanoma, but it is very low.  Congenital nevi have the most potential.


If a person has more than 100 moles, a family history of melanoma, and several large atypical nevi, there is a 50% chance of melanoma.  These individuals have to be followed carefully. Teenagers that fit this category should be fol­lowed like a hawk.


Early recognition and referral is essen­tial, followed by biopsy and surgical exci­sion. Adjunctive therapies have marginal additional value. The depth of the lesion is extremely important, with a depth of less than 1 mm being 95% cur­able and up to 3 mm being 40% curable.


There has been a 20-fold increase in the incidence of melanoma since 1930. This was  about the time that people decided to get silly and take off their clothes for recreational sun.


Dr. Knapp