Malignant melanoma is increasing quicker than any other cancer in the United States. Only about 0.3%-0.4% of people diagnosed with malignant melanoma are prepubertal children. Eighty percent of all malignant melanoma is caused from prolonged sun exposure. Frequent blistering sunburn as a child elevates the risk of developing malignant melanoma. Only 20% of the world’s melanomas occur in black Africans and Asians because of the darker skin pigmentation. The highest incidences of malignt melanoma is in Australia, which has started a large campaign to educated children in prevention: avoid direct sun light during the middle of the day, wear clothing and hats to limit sun exposure, and apply sunscreen.
Melanoma can be accurately diagnosed using a 7-point checklist, which is as follows:
- Change in size of lesion
- Change in shape of lesion
- Change in color of lesion
- Lesion inflammation
- Lesion bleeding or crusting
- Sensory changes in the pigmented lesion
- Lesion diameter of greater than 7mm
It is necessary to assess any new pigmented lesions carefully and perform a complete skin examination, because 50% of melanomas arise without pre-existing lesion. Inspection alone is 80% accurate on identifying an malignant melanoma. Biopsy remains the unequivocal means of assessing pigmented lesions. For all new cases of melanoma, a through examination of the whole skin and regional nodes is required. Any lymph node with and abnormal rubbery or firm consistency will need a biopsy. A baseline chest radiograph is indicated for patients with primary melanomas 1mm or greater. Computed tomography of the chest, abdomen, head, and pelvis are necessary to patients with nodal or distant metastatic dieses.
Malignant Melanoma is generally categorized into a system of 4 stages. The first stage is when the tumor is less than 1.5 mm thick. The second stage is when the tumor has grown greater than or equal too 1.5 mm and/or satellites are present within 2cm of the primary tumor. The third stage is regional lymph nodes with tumor and/or in-transit disease. The fifth and last stage is when the cancer turns to a distant metastatic disease.
There are many ways to treat malignant melanoma, but there is only one way to determine whether the treatment was successful, being the prompt and adequate excision of the primary lesion. Treatments consist of: excision of regional lymph nodes on a prophylactic basis, Chemotherapy, Radiotherapy, and resection of the tumor. Chemotherapy for metastatic dieses is associated with a 20% response rate, with a 50% response rate when combination chemotherapy is used. The main indications for the use of radiotherapy are for palliative treatment of unresectable local disease, bone metastases, and brain metastases.
Melanoma rare in children, and Dr. J. Craig Egan has a strong interest in treating these children. His experience in the US AirForce allowed him to garner significant adult melanoma experience before his specialty training in Pediatric Surgery. The vast majority of advanced stage pediatric melanoma surgery in Arizona is done by Dr. J. Craig Egan.
Dr. J. Craig EganPediatric Surgeon
Dr. J. Craig Egan completed a pediatric surgery fellowship and pediatric critical care fellowship at Medical College of Wisconsin/Children’s Hospital of Wisconsin. He is surgical co-director of the Pediatric Intensive Care Unit at Phoenix Children’s Hospital.