Melanoma Detection in Children

• Melanoma often goes undetected, especially in children. Indeed, because of its lower incidence there is often a low index of suspicion.
• Melanoma detection is a well-established science and the ABCDE criteria is a well established technique (combining wth dermoscopy if possible). Here is what the criteria  stand for:
  • A for Asymmetry
  • B for Border irregularity
  • C for Color variegation
  • D for Diameter more than 6mm
  • E for Evolution

• However these criteria do not seem to be effective when applied in children. In this study of 322 patients with melanoma, conventional ABCDE criteria detected less than half of melanomas in younger children (0 to 10 years of age) and less than 60% of melanomas in older children and teenagers (11-19).
• The study done by Dr Cordoro in the United States adopts different ABCD criteria which enables to miss almost no melanoma:
  • A for Amelanotic
  • B for Bleeding, Bump
  • C for Color uniformity
  • D for De Novo, any Diameter

• However, these criteria only raise suspicion of melanoma; pyogenic granulomas can also be easily included with these criteria. Insect bite reactions, folliculitis are common in children.
• That being said, practically speaking, observing suspicious amelanotic or papulonodular lesions for several weeks before doing a biopsy is appropriate.

A note about risk factors of melanoma in children:

• large congenital nevi are an individual risk factor for developing melanoma
• 50 or more melanocytic nevi
• dysplastic nevus syndrome
• sun-sensitive phenotype
• family history of melanoma
• DNA repair defects: xeroderma pigmentosum
• immunosuppression (induced or genetic)
• excessive ultraviolet radiation

Source: Dermatology World. Study suggests revised ABCD criteria for pediatric Melanoma. Van Vorhees AS. 09.2013