doctor examining child's skin

The ABCDE rules of melanoma screening for adults don’t apply to children.

There are distinct differences in the way melanoma appears in kids than it does in adults.

The difference in appearance does not apply to every single case, but rather, to enough cases such that a different set of screening rules has been devised for checking the skin of children.

At a 2011 presentation at the Pediatric Dermatology Annual Meeting, Cordoro et al presented findings from a study.

• Sixty percent of children under 10 years did not meet the traditional criteria for the ABCDE guidelines.

• Forty percent of adolescents also did not meet the criteria.

• Because of this, up to 82 percent of diagnoses took longer than six months after the first detection of the concerning skin spot.

• Sixty-two percent of diagnoses took more than two months to make.

How Do Kids’ Melanoma Look Different
than Adult Melanoma?

We can still refer to the guidelines as “ABCDE,” but the letters stand for differing things, says Cordoro et al.

A = Amelanosis or Amelanotic. This means flesh colored (skin tone, beige, whitish, pinkish), whereas in adults, melanoma often appears as a dark or black mole.

Though amelanotic melanoma also occurs in adults, it’s more common in children.

B = Bleeding or Bumpy. These features, too, occur in adults, but are just more common in the pediatric population.

A new bumpy lesion, in fact, may resemble a wart and even be diagnosed as a wart by a pediatrician – when in fact – it’s melanoma.

C = Color, as in, uniform. Children’s cancerous moles or spots are more likely to have color uniformity or one color. In adults, melanoma that arises in a mole frequently changes the mole to multiple colors.

D = De novo, Diameter. De novo means that the cancer arose out of regular skin rather than out of a pre-existing normal mole.

Diameter means that, more so in children, melanomas are smaller than six millimeters.

Adults are warned to keep an eye on moles that are the diameter of a pencil eraser.

Though adults can be diagnosed with melanomas as small as two millimeters, this is more common in kids.

E = Evolution. This is the only guideline that adults and children share for melanoma screening.

This refers to a mole changing over time, taking on a changing appearance.

“By comparison with adult cases, childhood melanoma can have a higher percentage of atypical clinical features (amelanotic and raised lesions), nodular histotype, and thick lesions,” says a paper in Pediatrics (2005, Ferrari et al).

“Don’t Worry About It”

If your gut has you feeling funny after a pediatrician told you your child’s “wart” or “growth” is “nothing to worry about,” seek a second opinion, ideally by a pediatric dermatologist – even if the first doctor was a pediatric dermatologist.

Insist on a biopsy. In fact, to play safe, get a second biopsy from a different lab, because false negative diagnoses are more likely with childhood melanoma than with adult. Not only do these cancerous tumors often look innocent to the naked eye in the pediatric population, but they may also appear innocent under a microscope.