The ‘ABCDE’ rule of melanoma does not apply to children

The ‘ABCDE’ rule of melanoma does not apply to children

According to a study led by researchers at the University of California in San Francisco, many children do not meet the classical criteria of melanoma ABCDE, which are the signs of this cancer. Melanoma is a cancer derived from melanocytes and represents about 5% of skin cancers, but its incidence is increasing. It is important to note that melanoma, although the rarest of skin cancer, is responsible for most deaths, the number of deaths from non-melanoma skin data cancers (basal cell carcinoma and squamous cell carcinoma) is four times less.

One of the important factors in the development of melanoma is exposure to sunlight and it has been shown that ultraviolet A and ultraviolet B rays (UVA and UVB) induce mutations in cellular DNA leading to uncontrolled proliferation. The use of sunbeds is also incriminated as a risk factor in the development of melanoma and it was found that the incidence of skin cancers, including melanoma, has increased with the widespread use of sunbeds. In addition it should be noted that sun exposure during childhood is a more important risk factor than sun exposure in adult life. In addition to sun exposure, other risk factors that are associated with melanoma are the skin type (white men and people with pale skin are more prone to make skin cancer), family history of melanoma, the presence of multiple melanocytic nevi etc.

It should be noted that not all melanocytic nevus is melanoma, there are several criteria that indicate malignancy and these are asymmetry (A), irregular borders (B), a change the color (C), diameter greater than 6 mm (D), elevation ( E). Doctors can use a special instrument called dermatoscope that differentiate melanoma from other lesions such as seborrheic keratosis. The aspect of a skin lesion raises suspicion of malignancy but it cannot make the final diagnosis, this requires confirmation by biopsy.

An article recently published in the Journal of the American Academy of Dermatology, shows that many children with melanoma do not meet the classical criteria: ABCDE, which means that the cancer may not be diagnosed in time. A team of researchers from the University of California in San Francisco, led by Kelly M. Cordoro, MD, conducted a retrospective study that included 60 children diagnosed with melanoma and 10 children with ambiguous melanocyte tumors who were diagnosed by age of 20. They were diagnosed in two groups: group A (ages 0-10 years) and group B (aged 11-19 years). It was found that 60% of group A and 40% in group B did not meet the ABCDE criteria. The most common signs were bleeding, amelanosis, variable diameter, de novo development. “Additional ABCD detection criteria (Amelanotic; Bleeding, Bump; Color uniformity; De novo, any Diameter) used together with conventional ABCDE criteria may facilitate earlier recognition and treatment of melanoma in children,” stressed  the authors.