Is My Child's Mole Suspicious?

A few years ago, Alexis Schott, 9, was getting ready for bed when her dad, Garrick, spotted a mole on her leg with a noticeably darker border. Concerned, he and his wife kept an eye on it. Two months later, the mark began to change.

A pediatric dermatologist confirmed it was an atypical spitz nevus -- a type of mole that resembles melanoma and can develop into melanoma if left untreated. "They said it's not cancerous, but it's precancerous," Schott says. "So the doctor removed it and asked to see us again in six months."

But before the next appointment, they noticed another suspicious-looking mole in the same small area on Alexis' leg, which has since been removed. And today, there's third one in the same vicinity -- which Garrick and his wife monitor nearly every single day.

Think the Schotts are going overboard? Think again. The American Academy of Dermatology currently projects one in five Americans will have skin cancer at some point in their lives. And although melanoma is rare in children under 10, it's on the rise. According to figures from the National Cancer Institute, the pediatric melanoma rate increased by an average of 2 percent each year between 1973 and 2009.

The chances of a small mole converting into skin cancer are relatively small -- the odds are less than two percent, says Nanette Silverberg, M.D., director of pediatric and adolescent dermatology at Mount Sinai Hospital in New York City -- but early detection is essential. If left unchecked, melanoma can easily spread to other parts of the body. That's why experts recommend that parents err on the side of caution, especially if there's a family history of skin cancer.

What does a melanoma look like?

You may already be familiar with the ABCDE signs of a melanoma:

• Asymmetry
• Border that's irregular
• Color that isn't uniform
• Diameter that is larger than a pencil eraser
• Evolution -- it's normal for a mole to gradually grow with a child, but any dramatic shifts may be cause for concern.

Still, figuring out whether your kid's odd-shaped mole is dangerous can be tricky. Symptoms can vary from child to child, and pediatric melanoma often presents differently than adult melanoma, says Andrea Cambio, M.D., a pediatric dermatologist and medical director at Cambio Dermatology in southwest Florida. "It can look like a wart and lack the brown [or] black pigment."

In fact, the majority of melanomas arise as a new growth, and some may even look like pink, flesh-colored bumps, according to Lauren Ploch, M.D., a member of the American Academy of Dermatology. "It can be subtle," she says.

You should also look for the "ugly ducklings," or moles that don't look like any of your child's other ones or are bleeding or have a sore within them, says Dr. Ploch.

When should your child see the dermatologist?

Moles and melanomas can grow anywhere, but they tend grow mostly on the arms, the face and scalp, and the upper back and chest, so be sure to thoroughly scan these body parts for any suspicious spots. Call a pediatric dermatologist if you notice any that fit the ABCDE criteria or if you spot any other markings that look worrisome.

An annual visit to the derm is in order if your child has more than 25 moles or a family history of melanoma or other type of cancer. She may need to go more than once a year if she has more than 50 moles, a history of abnormal moles, or a genetic or immunologic syndrome, says Dr. Cambio.

Otherwise, your pediatrician can check for suspicious skin lesions during annual physicals and routine exams. As far as other skin cancers go, both basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) are very rare in children and typically occur only in patients with genetic syndromes. The prevention protocol is the same -- do regular skin checks and stay out of the sun, Dr. Cambio says.

How to keep your child safe

Every three months, give your child's body a head-to-toe once-over, says Dr. Ploch. Use the American Academy of Dermatology's mole map as a guide. (Bonus: It works for your self-exams, too.) Take photographs for your records of any birthmarks; every month, compare the images and look for any changes in size, shape or color, Dr. Silverberg says. If there's a noticeable difference, if your doctor has suggested you have an evaluation, or if a new mole or funny looking spot crops up, call a pediatric dermatologist. She will evaluate and may do a biopsy and, if need be, remove the marking.

• AAD's How-To Detect Skin Cancer

Of course, your best bet is to practice sun smarts year-round. "More than three sunburns in children increases chances of melanoma exponentially," Dr. Ploch warns, noting that even non-blistering burns and sun exposure without a burn can increase the risk. So take extra precaution, and use sunscreen and protective clothing as a regular practice.

To prevent a burn, keep babies 6 months and younger in the shade as much as possible, advises Dr. Silverberg. From 6 months to 2 years, try to keep your babe out of the sun from 10 a.m. to 3 p.m., when rays are especially strong. Be sure to apply broad-spectrum sunscreen with titanium dioxide or zinc oxide and an SPF of at least 30 -- and reapply it every one to two hours if your little one is active or sweating. (This is good practice for older kids, too.) Sun hats and rash guards are great for kids of all ages, because they cover the skin and usually have an ultraviolet protection factor (UPF) of 50.

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