Skin Cancer (Melanoma, Squamous Cell, Basal Cell Cancer) in Children

Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin. The skin is the body’s largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer). Skin cancer begins in the epidermis, which is made up of three kinds of cells:

• Melanocytes: Found in the lower part of the epidermis, these cells make melanin, the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes make more pigment and cause the skin to darken.
• Squamous cells: Thin, flat cells that form the top layer of the epidermis.
• Basal cells: Round cells under the squamous cells.

There are three types of skin cancer:

• Melanoma.
• Squamous cell skin cancer.
• Basal cell skin cancer.

What Are the Risk Factors for Melanoma in Children?

Even though melanoma is rare, it is the most common skin cancer in children. It occurs more often in adolescents aged 15 to 19 years.

The risk of having melanoma is increased by having the following conditions:

• Giant melanocytic nevi (large black spots, which may cover the trunk and thigh).
• Xeroderma pigmentosum.
• Multiple endocrine neoplasia type I (MEN1) syndrome (Werner syndrome).
• Hereditary retinoblastoma.
• Having a weakened immune system.
• Other risk factors for melanoma in all age groups include:
• Having a fair complexion, which includes the following:
• Fair skin that freckles and burns easily, does not tan, or tans poorly.
• Blue or green or other light-colored eyes.
• Red or blond hair.
• Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
• Having several large or many small moles.
• Having a family history or personal history of unusual moles (atypical nevus syndrome).
• Having a family history of melanoma.

What Are the Signs and Symptoms of Melanoma in Children?

Signs and symptoms of melanoma include the following:

A mole that:

• changes in size, shape, or color.
• has irregular edges or borders.
• is more than one color.
• is asymmetrical (if the mole is divided in half, the 2 halves are different in size or shape).
• itches.
• oozes, bleeds, or is ulcerated (a hole forms in the skin when the top layer of cells breaks down and the
• tissue below shows through).
• Change in pigmented (colored) skin.
• Satellite moles (new moles that grow near an existing mole).

How Is Melanoma in Children Diagnosed?

Tests to diagnose and stage melanoma may include the following:

• Physical exam and history.
• X-ray of the chest.
• CT scan.
• MRI.
• PET scan.

Other tests and procedures used to diagnose melanoma include the following:

• Skin exam: A doctor or nurse checks the skin for bumps or spots that look abnormal in color, size, shape, or
• texture.
• Biopsy: All or part of the abnormal-looking growth is cut from the skin and viewed under a microscope by a pathologist to check for cancer cells. There are four main types of skin biopsies:
  • Shave biopsy: A sterile razor blade is used to “shave off” the abnormal-looking growth.
  • Punch biopsy: A special instrument called a punch or a trephine is used to remove a circle of tissue from the abnormal-looking growth.
  • Excisional biopsy: A scalpel is used to remove the entire growth.
  • Wide local excision: A scalpel is used to remove the growth and some of the normal tissue around the area, to check for cancer cells. Skin grafting may be needed to cover the area where tissue was removed.
• Sentinel lymph node biopsy: The removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes.
• Lymph node dissection: A surgical procedure in which lymph nodes are removed and a sample of tissue is checked under a microscope for signs of cancer. For a regional lymph node dissection, some of the lymph nodes in the tumor area are removed. For a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed. This procedure is also called a lymphadenectomy.

Treatment of melanoma is surgery to remove the tumor and some tissue around the tumor. If cancer has spread to nearby lymph nodes, treatment is surgery to remove the lymph nodes with cancer. Immunotherapy with high-dose interferon may also be given.

Treatment of melanoma that has spread beyond the lymph nodes may include the following:

• Chemotherapy, targeted therapy, and/or immunotherapy.
• A clinical trial of a new targeted therapy drug.

Treatment of recurrent melanoma in children may include the following:

• A clinical trial that checks a sample of the patient's tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.
• A clinical trial of a new targeted therapy drug.

What Are the Risk Factors for Melanoma?

Nonmelanoma skin cancers (squamous cell and basal cell cancers) are very rare in children and adolescents. The risk of squamous cell or basal cell cancer is increased by the following:

• Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
• Having a fair complexion, which includes the following:
  • Fair skin that freckles and burns easily, does not tan, or tans poorly.
  • Blue or green or other light-colored eyes.
  • Red or blond hair.
• Having actinic keratosis.
• Past treatment with radiation.
• Having a weakened immune system.

Signs of squamous cell and basal cell skin cancer include the following:

• A sore that does not heal.
• Areas of the skin that are:
  • Small, raised, smooth, shiny, and waxy.
  • Small, raised, and red or reddish-brown.
  • Flat, rough, red or brown, and scaly.
  • Scaly, bleeding, or crusty.
  • Similar to a scar and firm.

How Are Squamous Cell and Basal Cell Skin Cancer in Children Diagnosed?

Tests to diagnose squamous cell and basal cell skin cancer include the following:

• Skin exam: A doctor or nurse checks the skin for bumps or spots that look abnormal in color, size, shape, or texture.
• Biopsy: All or part of a growth that doesn't look normal is cut from the skin and viewed under a microscope by a pathologist to check for signs of cancer. There are three main types of skin biopsies:
  • Shave biopsy: A sterile razor blade is used to “shave off” the growth that does not look normal.
  • Punch biopsy: A special instrument called a punch or a trephine is used to remove a circle of tissue from the growth that does not look normal.
  • Excisional biopsy: A scalpel is used to remove the entire growth.

Treatment of squamous cell and basal cell cancer in children may include the following:

• Surgery to remove the tumor. This may include Mohs micrographic surgery.
  • Mohs micrographic surgery is a type of surgery used for skin cancers. The tumor is cut from the skin in thin layers. During surgery, the edges of the tumor and each layer of tumor removed are viewed through a microscope to check for cancer cells. Layers continue to be removed until no more cancer cells are seen. This type of surgery removes as little normal tissue as possible and is often used to remove skin cancer on the face.

Treatment of recurrent squamous cell and basal cell cancer in children may include the following:

• A clinical trial that checks a sample of the patient's tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.

For more information, read our full medical articles on skin cancer and melanoma signs, symptoms and treatment.