Melanoma in children and adolescents

Rare, but important to recognise

Paediatric melanoma is rare and occurs more often in adolescents than in younger children. Percentages and annual increases reported in historical US studies do not automatically describe current Italian patterns. Furthermore, childhood melanocytic tumours are not all melanomas: Spitz naevi, spitzoid tumours and lesions of uncertain behaviour may require particularly experienced assessment.

A new lesion that grows, bleeds without explanation, changes shape or colour or looks different from the others deserves attention. In young children it may be pink rather than dark and may resemble a wart or pyogenic granuloma. The ABCDE rule is helpful but does not identify every paediatric presentation. Small size, symmetry or a pink colour cannot guarantee that a lesion is harmless. Conversely, moles appearing or growing as a child grows are often benign; diagnosis requires examination and dermoscopy when appropriate.

Large or giant congenital naevi, particular genetic syndromes, immunosuppression and family history can modify risk. It is inaccurate to claim that most melanomas across all childhood ages necessarily arise in congenital moles. Surveillance depends on the individual context and does not justify removing every mole indiscriminately.

Sources: NCI — Childhood Melanoma Treatment (PDQ); NCI — Clinical guidelines for pediatric melanoma, 2024.

Diagnosis and treatment by an experienced team

When suspicion warrants biopsy, sampling must allow adequate histological assessment. An experienced paediatric dermatopathologist may review the specimen; selected lesions benefit from molecular testing to clarify classification. Laser treatment or destruction without tissue for analysis should not replace this diagnostic process.

Surgery is central to localised melanoma care. Margins, reconstruction and sentinel node biopsy are considered in relation to the actual diagnosis, thickness and age. A nodal finding in a spitzoid lesion should not automatically be interpreted as equivalent to conventional melanoma. Lymph node dissection is also a specialist decision, not a universal response to every positive finding.

Advanced disease may involve immunotherapy, targeted treatments or clinical trials, taking account of authorised ages, molecular findings, evidence and access in Italy. High-dose interferon should not be presented as the automatic modern standard. Decisions require paediatric oncology, dermatology, surgery and pathology expertise.

Prognosis depends on the precise diagnosis and extent of disease; a better outcome cannot be promised to all children below a particular age. Follow-up also addresses growth, late treatment effects and psychological wellbeing. Age-appropriate explanations, coordination with school and activities, and support for parents are part of care.

Sources: NCI — Childhood Melanoma Treatment (PDQ); NCI — Clinical guidelines for pediatric melanoma, 2024.

Protection and questions for the appointment

Preventing sunburn from childhood means planning shade, clothing, a hat and age-appropriate sunscreen on exposed skin, without using sunscreen to extend exposure. Sunbeds are not healthy preparation for sunlight. Ask the paediatrician or dermatologist how to manage congenital moles and family history without obsessive daily checks.

Before the appointment, record when the lesion appeared, how it changed and whether earlier photographs exist. Ask whether a second pathology opinion is needed, which centre coordinates treatment and how pain, schooling, future fertility where relevant and family support will be addressed. Working parents’ entitlements should be assessed separately with a social worker and patronato.

Sources: NCI — Common moles, dysplastic nevi and melanoma; NCI — Childhood Melanoma Treatment (PDQ).