Children Are the Future of Melanoma Prevention

SEATTLE — Teaching children and their parents about sun safety is the best way to reduce the risk of melanoma both during childhood and later in life, according to Dr. Annette M. Wagner, a pediatric dermatologist at Northwestern University in Chicago.

"There is an epidemic of melanoma," she said at a meeting sponsored by the American Academy of Pediatrics, noting that the incidence is rising among both pediatric and adult populations. "Just because you see only children, do not believe you don't have to worry."

Adolescents should be counseled about the deadliness of melanoma, Dr. Wagner advised.

"They don't know how dangerous this is," she said. "Every one of them believes that parents who smoke cigarettes are crazy because that can cause lung cancer. But they don't know that they are at more risk of getting a melanoma from going in the tanning booth than their parents ever were of getting lung cancer from smoking."

Pediatricians also should teach all children, starting at a young age, about wearing sunscreen daily.

"When you are doing your general care for pediatric patients, just like you talk about brushing teeth and wearing seat belts, you have got to teach them to put on sunscreen," Dr. Wagner noted. "If you teach a child under the age of 2 to wear sunscreen, they will wear it every day."

Sunscreens with a sun protection factor (SPF) greater than 30 provide minimal additional protection against solar radiation, compared with those with an SPF of 30, Dr. Wagner noted. If anything, suncreens with an SPF greater than 30 are likely to contain a greater number of chemicals that can be irritants.

She advocated choosing sunscreens that contain only a physical radiation blocker—zinc oxide or titanium dioxide—often marketed as chemical-free sunscreens. "They are not hard on sensitive skin, they don't sting or burn when you rub them into your eyes, and they are much better tolerated in the pediatric population," she explained.

"You can and should put sunscreen on all infants who are outside," she continued, even those younger than 6 months of age. However, clothing remains the best form of sunscreen for young infants, if it can provide adequate protection.

Recent concerns about vitamin D deficiency should be addressed with a multivitamin supplement containing this vitamin, she said. "I would never, ever use concerns about vitamin D as an excuse for not using sunscreen."

When it comes to moles, educating parents and children about warning signs is key, said Dr. Wagner. The A, B, C, D's of melanoma—asymmetry, border irregularity, color variation, and diameter greater than 6 mm—are not very helpful in the pediatric population because children tend to get monomorphous moles that all look alike.

Therefore, when trying to determine which moles to worry about in younger children, she recommended using the Ugly Duckling or Sesame Street rule: "It's that one mole that does not look like the others, and therefore it does not belong."

Although a black lesion is what most often comes to mind with melanoma, this cancer often has a different appearance in children.

"The most common presentation of a melanoma in a child is a rapidly growing pink papule," Dr. Wagner emphasized. And these papules may resemble Spitz nevi, so "don't ever ignore a Spitz nevus on a child."

In the pediatric population, moles that itch or bleed are generally not worrisome, unless the bleeding is spontaneous, she said. But size is important. "If you have a mole in a child at any age that is smaller than their thumbnail, the risk of melanoma is less than 1%, and that mole probably does not require anything but observation," she said. Larger moles require a referral to a specialist.

Dr. Wagner reported that she had no conflicts of interest relevant to her presentation.

SEATTLE — Teaching children and their parents about sun safety is the best way to reduce the risk of melanoma both during childhood and later in life, according to Dr. Annette M. Wagner, a pediatric dermatologist at Northwestern University in Chicago.

"There is an epidemic of melanoma," she said at a meeting sponsored by the American Academy of Pediatrics, noting that the incidence is rising among both pediatric and adult populations. "Just because you see only children, do not believe you don't have to worry."

Adolescents should be counseled about the deadliness of melanoma, Dr. Wagner advised.

"They don't know how dangerous this is," she said. "Every one of them believes that parents who smoke cigarettes are crazy because that can cause lung cancer. But they don't know that they are at more risk of getting a melanoma from going in the tanning booth than their parents ever were of getting lung cancer from smoking."

Pediatricians also should teach all children, starting at a young age, about wearing sunscreen daily.

"When you are doing your general care for pediatric patients, just like you talk about brushing teeth and wearing seat belts, you have got to teach them to put on sunscreen," Dr. Wagner noted. "If you teach a child under the age of 2 to wear sunscreen, they will wear it every day."

Sunscreens with a sun protection factor (SPF) greater than 30 provide minimal additional protection against solar radiation, compared with those with an SPF of 30, Dr. Wagner noted. If anything, suncreens with an SPF greater than 30 are likely to contain a greater number of chemicals that can be irritants.

She advocated choosing sunscreens that contain only a physical radiation blocker—zinc oxide or titanium dioxide—often marketed as chemical-free sunscreens. "They are not hard on sensitive skin, they don't sting or burn when you rub them into your eyes, and they are much better tolerated in the pediatric population," she explained.

"You can and should put sunscreen on all infants who are outside," she continued, even those younger than 6 months of age. However, clothing remains the best form of sunscreen for young infants, if it can provide adequate protection.

Recent concerns about vitamin D deficiency should be addressed with a multivitamin supplement containing this vitamin, she said. "I would never, ever use concerns about vitamin D as an excuse for not using sunscreen."

When it comes to moles, educating parents and children about warning signs is key, said Dr. Wagner. The A, B, C, D's of melanoma—asymmetry, border irregularity, color variation, and diameter greater than 6 mm—are not very helpful in the pediatric population because children tend to get monomorphous moles that all look alike.

Therefore, when trying to determine which moles to worry about in younger children, she recommended using the Ugly Duckling or Sesame Street rule: "It's that one mole that does not look like the others, and therefore it does not belong."

Although a black lesion is what most often comes to mind with melanoma, this cancer often has a different appearance in children.

"The most common presentation of a melanoma in a child is a rapidly growing pink papule," Dr. Wagner emphasized. And these papules may resemble Spitz nevi, so "don't ever ignore a Spitz nevus on a child."

In the pediatric population, moles that itch or bleed are generally not worrisome, unless the bleeding is spontaneous, she said. But size is important. "If you have a mole in a child at any age that is smaller than their thumbnail, the risk of melanoma is less than 1%, and that mole probably does not require anything but observation," she said. Larger moles require a referral to a specialist.

Dr. Wagner reported that she had no conflicts of interest relevant to her presentation.

SEATTLE — Teaching children and their parents about sun safety is the best way to reduce the risk of melanoma both during childhood and later in life, according to Dr. Annette M. Wagner, a pediatric dermatologist at Northwestern University in Chicago.

"There is an epidemic of melanoma," she said at a meeting sponsored by the American Academy of Pediatrics, noting that the incidence is rising among both pediatric and adult populations. "Just because you see only children, do not believe you don't have to worry."

Adolescents should be counseled about the deadliness of melanoma, Dr. Wagner advised.

"They don't know how dangerous this is," she said. "Every one of them believes that parents who smoke cigarettes are crazy because that can cause lung cancer. But they don't know that they are at more risk of getting a melanoma from going in the tanning booth than their parents ever were of getting lung cancer from smoking."

Pediatricians also should teach all children, starting at a young age, about wearing sunscreen daily.

"When you are doing your general care for pediatric patients, just like you talk about brushing teeth and wearing seat belts, you have got to teach them to put on sunscreen," Dr. Wagner noted. "If you teach a child under the age of 2 to wear sunscreen, they will wear it every day."

Sunscreens with a sun protection factor (SPF) greater than 30 provide minimal additional protection against solar radiation, compared with those with an SPF of 30, Dr. Wagner noted. If anything, suncreens with an SPF greater than 30 are likely to contain a greater number of chemicals that can be irritants.

She advocated choosing sunscreens that contain only a physical radiation blocker—zinc oxide or titanium dioxide—often marketed as chemical-free sunscreens. "They are not hard on sensitive skin, they don't sting or burn when you rub them into your eyes, and they are much better tolerated in the pediatric population," she explained.

"You can and should put sunscreen on all infants who are outside," she continued, even those younger than 6 months of age. However, clothing remains the best form of sunscreen for young infants, if it can provide adequate protection.

Recent concerns about vitamin D deficiency should be addressed with a multivitamin supplement containing this vitamin, she said. "I would never, ever use concerns about vitamin D as an excuse for not using sunscreen."

When it comes to moles, educating parents and children about warning signs is key, said Dr. Wagner. The A, B, C, D's of melanoma—asymmetry, border irregularity, color variation, and diameter greater than 6 mm—are not very helpful in the pediatric population because children tend to get monomorphous moles that all look alike.

Therefore, when trying to determine which moles to worry about in younger children, she recommended using the Ugly Duckling or Sesame Street rule: "It's that one mole that does not look like the others, and therefore it does not belong."

Although a black lesion is what most often comes to mind with melanoma, this cancer often has a different appearance in children.

"The most common presentation of a melanoma in a child is a rapidly growing pink papule," Dr. Wagner emphasized. And these papules may resemble Spitz nevi, so "don't ever ignore a Spitz nevus on a child."

In the pediatric population, moles that itch or bleed are generally not worrisome, unless the bleeding is spontaneous, she said. But size is important. "If you have a mole in a child at any age that is smaller than their thumbnail, the risk of melanoma is less than 1%, and that mole probably does not require anything but observation," she said. Larger moles require a referral to a specialist.

Dr. Wagner reported that she had no conflicts of interest relevant to her presentation.