PHILADELPHIA – Melanoma, a potentially deadly skin cancer that usually affects adults, is showing up with increasing frequency in children.

Melanoma is still a rare disease in children, with an estimated 500 cases a year in this country. But experts are alarmed by a steady increase in its prevalence among children and teens over the past few decades.

A study published in July documented a 2.9 percent increase a year in pediatric melanoma from 1973 to 2001 in the United States.

“You just can’t say melanoma doesn’t happen in children. It can,” said Daniel Krowchuk, a professor of pediatrics and dermatology at Wake Forest University who heads the American Academy of Pediatrics’ dermatology committee.

Experts suspect early sun exposure is one factor but acknowledge they don’t know all the reasons.

Over the past decade, adults have been hearing public health messages to watch their sun exposure and be alert for suspicious changes in the shape and color of moles and other skin lesions. Now, Krowchuk said, pediatricians and parents alike also need to be vigilant.

“Sometimes it’s right in front of a physician’s nose and it’s ignored or blown off as something else,” said Casey Culbertson, a pediatric cardiologist at Children’s Hospital and Research Center in Oakland, Calif., who heads the Melanoma Research Foundation.

In children and adults, melanoma is highly curable if diagnosed early, while still confined to the top layers of the skin. But it can spread to nearby lymph nodes and other parts of the body, making it difficult or impossible to cure. Melanoma is a far more worrisome skin cancer than basal cell or squamous cell cancers, which are more easily dealt with.

The July study, published in the Journal of Clinical Oncology, found that pediatric melanoma increased especially among white children, females, older children, and those living in areas where people are exposed to more UV radiation from the sun.

The study found that the overall five-year survival rate for children with melanoma was 93.6 percent. Children with advanced disease had a survival rate of 57 percent.

“The incidence of melanoma is increasing rapidly in children, especially in adolescents,” concluded the researchers, headed by J.J. Strouse, a pediatric oncologist and hematologist at Johns Hopkins University. “This increase is similar to that seen in young adults.”

Strouse, in an interview, said sun exposure in childhood seems to play a role in the increase, but other potential factors need to be studied further. For instance, he said, the popularity of suntanning booths, particularly with teen girls, is exposing people to UV radiation. Also, hormonal influences, perhaps linked to early puberty, could be a factor, he said.

Some experts believe the rise in melanoma can be partly blamed on the thinning of the Earth’s ozone layer, which offers protection against ultraviolet radiation from the sun.

Sunscreens can also provide a false sense of security, encouraging people to stay in the sun longer. And until recently, sunscreens typically protected against ultraviolet-B, but not ultraviolet-A. Both are damaging to the skin. Having one or more blistering sunburns in childhood increases the chances of developing melanoma later on.

Anthony J. Mancini, a dermatologist at Children’s Memorial Hospital in Chicago, said his institution formed a pediatric melanoma committee after more cases started to turn up, including a 4-year-old with the cancer.

“We’re up to about 12 cases in almost nine years,” compared with only a few cases in the prior two decades, said Mancini, who is writing an article on the phenomenon for the American Academy of Pediatrics’ newsletter.

Dermatologists say they are seeing more children referred by other doctors for mole checks, or by parents who have a heightened awareness of dangers of melanoma.

On a recent afternoon, Lynda Williams of Schwenksville, Pa., brought her 12-year-old son, Kyle, to see Albert Yan, director of pediatric dermatology at Children’s Hospital of Philadelphia.

She wanted a second opinion after another dermatologist recommended that a large mole be removed.

Williams said she wasn’t eager for her child to undergo surgery, but also didn’t want to take a lax attitude.

“I’d feel terrible if something did come up,” she said.

Yan was reassuring.

“My personal opinion is that it looks benign. Chances are low something will happen to this one,” he told Kyle and his mother. “At this point, it’s fine to watch and leave it as it is.”

He recommended that they keep an eye out for changes in the shape and color of the mole. He also suggested that Kyle see a dermatologist for yearly check-ups.

In cases where patients have many moles, Yan advises them to follow the “ugly duckling rule” – if one mole stands out from the pack, it could be troublesome.

For adults, doctors have come up with a list of criteria to flag suspicious lesions. For starters, there are the ABCDE rules – a mole may be suspicious if it has an asymmetrical shape; an uneven border; various shades of coloring; is larger than the diameter of a pencil eraser; or evolves or changes over time.

But a recent study out of Italy suggests that spotting a pediatric melanoma may be tricky. Researchers reported on 33 cases and found that only half of them did have the characteristic features. For instance, the lesion was pinkish or reddish, not the more typical dark brown.

“Although we have no data to support any suggestion of biological differences between young children and adolescents or adults, our findings give the impression that melanoma behaves differently in the younger age group,” concluded the researchers, reporting in the March issue of Pediatrics.

Pam and Joe Rohr of Sicklerville, N.J., said their daughter, Jenni, was 13 when she had three moles removed. One, on her upper back, turned out to be cancerous.

“When we found out it was melanoma, she was very surprised, as were we,” said Pam Rohr, especially since the family was diligent about using sunscreen.

Further surgery and testing showed the cancer had spread to Jenni’s lymph nodes, so she began a series of treatments, including radiation and chemotherapy.

Eventually, the cancer spread to her lungs.

“All she wanted to do was go to high school and do what every other normal teenager wants to do,” Rohr said.

Jenni died two years ago at age 14, just after starting ninth grade.

“Parents need to be aware that it could happen,” said Rohr. “If you see a funny looking mole, you need to get it checked and doctors need to be aware.”

(c) 2005, The Philadelphia Inquirer.

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