r eg i o n a l de r m a t o l o gy o f d u r h a m , p l l c

ediatric melanoma is still uncom- again, that it is essential to protect children bumps on the side of the face, similar to the “ mon in children,” notes Dr. from excessive exposure to the sun. Chil- little rough bumps around hair follicles on Pediatric PElizabeth Hamilton of Regional dren’s skin is much more fragile than the skin the back of the arms. Dermatology of Durham, “but in my of adults, and thus much more susceptible to The condition is harmless, and tends to early practice days, more than 20 years damage from UV rays. We also emphasize improve with age. Treatment with moistur- Melanoma: ago, it was very rare. sun protection for children because this is izers and some prescription medications is “Now we are nationally experiencing as when they will develop good habits. helpful. many as 500-plus cases each year. The Skin The guidelines for older children are Rare, Cancer Foundation reports that overall, similar to those for adults: avoid unprotect- H&H: And pityriasis alba? pediatric melanoma, while still uncommon, ed exposure during the peak sun hours; seek increased by an average of two percent per shade; wear sun-protective clothing—big DR. HAMILTON: This is relevant, especially But on year in the most recent decade. brim hats, sun glasses, shirts—and use sun- during swim season. Pityriasis alba is a mild “Melanoma in children can be difficult screen that is broad spectrum and greater form of eczema where the loss of color is to diagnose,” she notes. “Since it is rare, the than SPF 30. more visible than redness. In dark skin it the Rise index of suspicion tends to be low. So on For infants, sun avoidance is recom- can be very dramatic—in children and less a statistical basis, the likelihood of a lesion mended. They should be out of the sun or often in adults—because it causes highly being melanoma in a young child is small. covered up. Toddlers get a little more chal- visible light spots, much like light finger- Secondly, biopsing a spot on a young child lenging. I emphasize sun-protective cloth- prints on the face. Sometimes it becomes can be a challenge. A simple procedure on ing, avoiding the mid-day sun, and favor so generalized that there are big, round “Pediatric melanoma an adult can be an ordeal for a child. Some- sun block (chemical free) creams. Parents patches where the skin is much lighter than times a child will have to be put to sleep like the convenience of sprays but recently the normal skin color—with a bit of scaling, for a biopsy. This requires referral, another there has been concern of inhaled products. but not a great deal. Sun exposure tends to increased by an visit for the parent and patient, and then the It is now recommended that sprays be ap- make it more apparent as the affected areas procedure. In other words, it is a hassle and plied with the hands or closely onto the skin do not tan. average of two while we would always rather be safe that so that little product is airborne. Too often, pityriasis alba is confused sorry, it is not always easy to achieve. I continue to advocate for balance. with other skin conditions and is improp- percent per year “Lastly, melanomas in young children Arrange protected playtime for kids in erly treated with anti-fungal agents without do not always have the usual characteristics the safer parts of the day—early to mid- success. The condition has nothing to do in the most of a melanoma. Melanomas in children morning, and mid-afternoon into the early with fungus. For treatment, we recommend before puberty are more likely to lack color evening. Simply stay out of the hot blister- gentle skin care and prescribe a mild topi- recent decade.” and may even resemble warts, which are ing mid-day sun when the most damage can cal steroid and as always sun protection to very common in children. be done, even when you feel well protected minimize the cosmetic impact. h&h “As a child ages into adolescence and from UV rays. puberty,” Dr. Hamilton notes, “the conven- tional rules of melanoma detection (A-B-C- Health&Healing: Do you believe it’s wise D: Asymmetry, Border irregularity, Color for parents to have moles, rashes, and skin variegation, Diameter > 6mm or Dark) tend irregularities in their children checked by a to be helpful. But for all ages, the most im- dermatologist? portant characteristic is E for Evolution or change. Change in a spot is the single most DR. HAMILTON: In general, I think pe- common trait of a melanoma.” diatricians often treat rashes effectively The risk factors for melanoma in and that’s fine as long as the condition is children depend on the age, Dr. Hamilton improving. Most pediatricians are quick explains. “Before the age of 10, the vast ma- to refer a rash that is not getting better or jority of children who develop melanoma to evaluate a mole, birthmark, and other do not have obvious risk factors. Those skin conditions beyond the typical bumps, that do have either a large birth mole, a past bruises, and classic problems such as history of cancer or other condition that poison ivy. They also do a pretty good job compromised their immune system. of knowing when to refer to a pediatric “Over the age of 10, the risk factors for dermatologist or a general dermatologist. melanoma resemble those of adults. Those are fair skin type, history of multiple blister- H&H: There are, we suspect, skin conditions ing sunburns, family history of melanoma, that are more common to young people. and lots of moles—usually more than 50.” DR. HAMILTON: Yes. Examples would Health&Healing: The drumbeat about protecting include keratosis pilaris and pityriasis

ourselves from the sun’s rays continues. alba—both quite common. Keratosis pi- g n i l a e h & h lt a e h laris, which is not uncommon in adults, is DR. HAMILTON: The one risk factor that we the result of skin cells collecting at the up- can control is sun exposure and sun burns. per opening of hair follicles, resulting in an Dr. Hamilton offers a young patient advice about The Skin Cancer Foundation also tells us inherited condition. The plugs cause small, skin care and protection. For more information about skin that sustaining five or more sunburns in pointed bumps to occur, most commonly conditions and treatment, contact: the youthful years increases lifetime mela- on the upper arms, thighs, buttocks, and REGIONAL DERMATOLOGY e m lu Vo • noma risk by 80 percent. It’s worth noting cheeks of the face. The skin has a rough OF DURHAM, PLLC that of the seven most common cancers texture. Elizabeth H. Hamilton, MD, PhD Amy Stein, MD in the U.S., melanoma—the most deadly On the face, keratosis pilaris is often 1 form of skin cancer—is the only one mistaken for acne, and we see some young Julie Dodge, PA-C 5 r e b m u N 7 whose incidence is increasing. Between adolescents with both. As the acne becomes 4321 Medical Park Drive, Suite 102 2000 and 2009, the incidence of melanoma fully developed, the keratosis pilaris simply Durham, NC 27704 climbed by two percent annually. goes away. In infancy, some people call Telephone: (919) 220-7546 (SKIN) And so we repeat to parents, again and keratosis pilaris “milk bumps”—little white www.dermatologydurham.com 21 Originally published in Health & Healing in the Triangle, Vol. 17, No. 5, Health & Healing, Inc., Chapel Hill, NC, publishers. Reprinted with permission.