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 Pediatric Treatment Facilities. Note: this list is not a doctor or treatment center recommendation list - only a list of treatment centers that have experience treating pediatric melanoma.
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.
Immunotherapies help the body’s natural immune response fight the cancer. Immunotherapy is often used in advanced melanoma when the cancer has spread to other parts of the body. FDA approved immunotherapies for pediatric melanoma include:
- Interferon alpha-2b - A number of pediatric patients have had success using interferon after being diagnosed with a later stage (Stage III or IV) melanoma. Although Interferon is a difficult treatment for adults to tolerate, younger patients tend to tolerate the drug much better than adult melanoma patients. A 2009 study discusses this in more detail. Most pediatric patients remain on Interferon for one year.
- 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 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.
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.