What is skin cancer?

Skin cancer is a malignant tumor that grows in the skin cells. Common types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma. Skin cancer is not common in children. Melanoma accounts for up to 3 percent of all pediatric cancers. 

Causes

Exposure to sunlight is the major contributing factor to developing skin cancer later in life. In particular, blistering sunburns in childhood and adolescence significantly increase the risk of developing malignant melanoma later in life.

Limiting exposure to sunlight in children and teens may pay large dividends in preventing skin cancers later in life.

Types

There are three main types of skin cancer:

• Basal cell carcinoma is a highly treatable cancer and grows very slowly. Basal cell carcinoma usually appears as a small, shiny bump or nodule on the skin, mainly those areas exposed to the sun, such as the head, neck, arms, hands, and face. Basal cell carcinoma is the most common type of skin cancer in adults, but is uncommon in children except in some genetic conditions such as basal cell carcinoma syndrome and xeroderma pigmentosum.
• Squamous cell carcinoma, although more aggressive than basal cell carcinoma, is highly treatable. Squamous cell carcinoma may appear as nodules or red, scaly patches of skin, and may be found on the face, ears, lips and mouth. Squamous cell carcinoma is rare in children.
• Melanoma accounts for a small percentage of all skin cancers, but accounts for most deaths from skin cancer. Melanoma starts in the cells that produce pigment in the skin. Melanoma sometimes appears as a new or changing mole. This cancer may spread quickly.

Distinguishing benign moles from melanoma

To find melanoma early, it is important to examine your child's skin on a regular basis, and become familiar with moles, and other skin conditions, in order to better identify changes. Recognizing changes in your child's moles is crucial in detecting melanoma at its earliest stage. 

It is normal for children to develop new moles over time, so the traditional ABCDEs of melanoma in adults differ in children. Pediatric melanoma often presents as a pink or red new bump that is uniform in color and can be of any diameter. A changing, or evolving mole can also be concerning.

The ABCDEs of pediatric melanoma are:

• A Amelanotic, meaning not the traditional brown, tan, blue or black color normally associated with a mole or melanoma
• B Bleeding, Bump
• C Color uniform
• D De novo (new), any Diameter
• E Evolution, meaning changing in size, shape or other characteristics

Melanomas vary greatly in appearance. New red or pink bumps or moles that are itchy or bleeding should be checked by your child's doctor. Always consult your child's doctor if you have questions about a mole or other skin lesion.

What are the risk factors for skin cancer?

Skin cancer is more common in fair-skinned people, especially those with blond or red hair, who have light-colored eyes. Skin cancer is rare in children. However, no one is safe from skin cancer. Other risk factors include:

• Family history of melanoma
• Sun exposure. The amount of time spent unprotected in the sun directly affects your child's risk of skin cancer.
• Early childhood sunburns. Research has shown that sunburns early in life increase a child's risk for skin cancer later in life. Sun exposure early in life is a major contributing factor to developing skin cancer.
• Many freckles
• Atypical moles/nevi
• Prior radiation therapy
• Lowered immunity, such as in people who have had organ transplants
• Certain rare, inherited conditions such as basal cell nevus syndrome (Gorlin syndrome) or xeroderma pigmentosum (XP)

Prevention of skin cancer

The following steps have been recommended by the American Academy of Dermatology (AAD) and the Skin Cancer Foundation to help reduce the risk of sunburn and skin cancer:

1. Minimize exposure to the sun at midday, between the hours of 10 a.m. and 4 p.m.
2. Apply sunscreen with an SPF-30 or higher that protects against both UVA and UVB rays, to all areas of your child's body (older than 6 months of age) that are exposed to the sun.
3. Reapply sunscreen every two hours, even on cloudy days. Reapply after swimming or perspiring. Reapply every 40 or 80 minutes (depending on what the sunscreen bottle indicates) when spending time in the water.
4. Remember, sand and pavement reflect UV rays even under an umbrella. Snow is a particularly good reflector of UV rays. which can increase the chance of sunburn.
5. Make sure your child wears clothing that covers the body and shades the face. Hats should provide shade for both the face, ears, and back of the neck. Wearing sunglasses will reduce the amount of rays reaching the eye and protect the lids of the eyes, as well as the lens.
6. Never use sunlamps or tanning parlors.
7. Protect children from excessive sun exposure when the sun is strongest (between 10 a.m. and 4 p.m.) by having them play in the shade, wear sun-protective clothing (UPF), and use sunscreen liberally and frequently for children 6 months of age and older.
8. Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't seek the sun.

The American Academy of Pediatrics approves of the use of sunscreen on infants younger than 6 months old if adequate clothing and shade are not available. Parents should still try to avoid sun exposure and dress the infant in lightweight clothing that covers most surface areas of skin. However, parents may apply a minimal amount of sunscreen to the infant's face and back of the hands.

How to perform a skin examination

Finding suspicious moles or skin cancer early is the key to treating skin cancer successfully. Examining your children (and yourself) is usually the first step in detecting skin cancer. The following suggested method of examination comes from the AAD:

• Examine your child's body front and back, then the right and left sides, with arms raised.
• Look carefully at your child's forearms, the back of his or her upper arms and the palms of the hands. Check between the fingers and look at the nail beds.
• Look at backs of his legs and feet, spaces between the toes, the toenail beds and the soles of the feet.
• Examine the back of his or her neck and scalp.
• Check his or her back, buttocks and genital area.
• Become familiar with your child's skin and the pattern of moles, freckles and other marks.
• Be alert to changes in the number, size, shape and color of pigmented areas.
• Follow the ABCDEs when examining moles of other pigmented areas and consult your child's doctor promptly if you notice any changes.