Treating Pediatric Melanoma

Your child’s stage of diagnosis is important to determine so the best treatment plan can be put into place. It is important to know that you have choices when it comes to where to seek treatment for your child. Not all treatment centers follow the same protocol for treating pediatric melanoma. It is important that you gather all the facts and make your decision based on what is best for your family. To get you started, you may like to see a list of treatment facilities below:

Note: this list is not a doctor or treatment center recommendation list - only a list of treatment centers that have experience treating pediatric melanoma. If you are aware of a facility that should be added, please email education@melanoma.org

Surgery

Surgery – a wide excision of the tumor – is the most common treatment for melanoma. The surgeon removes the melanoma and the surrounding tissue. The thickness of the melanoma will determine the amount of tissue removed and whether the surgery is an in- or out-patient procedure. A local anesthesia will likely be used. The severity of the scar will depend on the size, depth and location of the tumor.

Whereas early stage melanomas usually just need observation after surgery, thicker melanomas, or those that have spread to the lymph nodes, may require additional treatment. In the case of a thicker or ulcerated melanoma, your surgical oncologist will likely discuss two procedures: lymphatic mapping and sentinel lymph node (SLN) biopsy. If the SLN is cancer free, then no other lymph nodes will need to be checked or removed. If the SLN contains melanoma, your doctor may discuss further surgery and additional treatment.

Regional Lymph Node Metastasis

If melanoma has spread to the regional lymph nodes, a surgical procedure known as lymph node dissection is often performed. This procedure consists of removal of the “compartment” of lymph nodes related to the location of where the tumor-containing lymph node was identified. This procedure is performed under general anesthesia; one or more drain tubes are usually placed at the completion of surgery to facilitate recovery. 

Treatment

As pediatric melanoma is rare, generating knowledge, designing clinical trials and developing effective treatments is a challenge. To gain FDA approval, a treatment generally must first demononstrate efficacy in adults. It will then undergo a complex process to determine dosing and how it will interact with a child's body, and then an estimation on how similar the reponse will be beween an adult and a child.   

Ipilimumab

On July 24, 2017, the FDA approved the immunotherapy ipilimumab, also known as Yervoy, for patients ages 12 years and older with unresectable or metastatic melanoma. Ipilimumab is a checkpoint inhibitor that was first approved in 2011 for the treatment of adults with melanoma in both the unresectable or metastatic setting as well as an adjuvant therapy after complete removal of the tumor. 

Some Stage IV pediatric melanoma patients have used other immunotherapies that have been approved by the FDA for adult patients. These options should be discussed with your child's oncologist.

Clinical Trials

Clinical trials are sometimes viewed as the best treatment option for adult melanoma patients. For children with melanoma, especially those with recurrent or Stage IV disease, clinical trials may be appropriate to consider. As with all treatment options, clinical trials should be discussed thoroughly with your child's oncologist.

A 2014 study published in the Journal of Investigative Dermatology provided a comprehensive genomic analysis of pediatric melanoma - finding unique genomic features for each of the three subtypes of pediatric melanoma - and suggests compelling evidence that UV exposure may play more of a role than initially thought in this disease. The data from this study suggest that therapeutic targets for genotype-specific (such as BRAF) melanoma in adults might also be applicable to pediatric patients. 

Life After Treatment

If your child has had a melanoma, they are at higher risk of developing new melanomas than someone who has never had a melanoma. They may be at risk of the cancer coming back in nearby skin or other parts of the body. The chance of recurrence is greater if the melanoma was thick or had spread to nearby tissue. Other members of your family also should have regular checks for melanoma. 

To increase the chance of finding a new or recurrent melanoma as early as possible, follow your doctor's schedule for regular checkups and be sure to examine your child’s skin monthly (or have them do it themselves, if they are old enough to do it properly). 

If your child is at high-risk for recurrence, follow-up care may include x-rays, blood tests and imaging scans of the chest, liver, bones and brain. If your child was diagnosed with early stage (Stage I or II) melanoma, these tests may not be performed. Visit our Living with Melanoma section to learn more. 

504 Plan

After a melanoma diagnosis, your child will qualify for a 504 Plan. This will help you as you navigate the school system and work with teachers and administrators to ensure that your child can go to school with sunscreen and other sun protection measures.