As the warm weather approaches, my thoughts are turning happily toward outdoor fun and other summer plans. But I'm also gearing up to see the one sight at the beach that makes me cringe: a redheaded youngster, delightedly constructing a sand castle under the blazing sun, with that telltale pink creeping down her shoulders and back.

It's not just that I know she may be in pain by the end of the day. It's that sunburn during childhood is one of the biggest risk factors for developing skin cancer - and it's preventable. Which brings me to a very rare but potentially serious condition: pediatric melanoma.

Melanoma diagnosis is scary, and can be more complicated in kids because the pediatric warning signs can be different from warning signs in adults. But the good news is that, in addition to being rare - there are just 1.1 cases per million children under the age of 10 - pediatric melanoma is usually preventable and treatable with early detection.

Of slightly more concern is teenage melanoma, which is already more common than pediatric melanoma - 10 cases per million adolescents age 10 and older - and is increasing about 2 percent each year. Among females ages 15 to 29, melanoma is now the second most common cancer, according to the American Academy of Dermatology. Some of that increase may be due to better awareness and reporting, but much of it can be tied to the use of indoor tanning booths, which use ultraviolet radiation (UV), a known carcinogen.

Whatever the age of your child, it's important to be vigilant about skin changes and to be smart about melanoma prevention.

The ABCDE's of detection

Melanoma is a form of skin cancer that occurs when the skin cells that produce our skin's color, called melanocytes, grow out of control. If melanoma is diagnosed in its early stages, it can usually be treated fairly easily by cutting it out. Melanoma's scary reputation stems from what happens when its early signs are missed or ignored, and it spreads to the brain or other internal organs - that's when it can become deadly.

Many of us are familiar with the adult warning signs of melanoma. ABCDE is a handy reminder to describe a mole that should be checked by a board-certified dermatologist. Since teen melanoma is more likely to follow the adult pattern, be sure to employ the ABCDE checklist when monitoring your adolescent:

  • A symmetrical shape

  • B order irregularity

  • C olor changes

  • D iameter bigger than a pencil eraser (larger than 6mm)

  • E volving over time

But for kids under 10, the signs don't necessarily follow this pattern: the first symptom could be as simple as a new pink bump. So, while you definitely want to follow up on a skin lesion that has an irregular color and changes over time, also know that any new bump - especially if it bleeds or doesn't go away after a few months - warrants a visit to the pediatrician, who may follow up with a referral to a board-certified dermatologist or, even better, a pediatric dermatologist.

Since melanoma in kids under 10 does not always meet the common criteria for teens and adults, a new set of ABCD criteria has been proposed for pediatric patients:

  • A for amelanosis (no dark color)

  • B for bumps or bleeding

  • C for color uniformity (versus color variability in teens and adults)

  • D for diameter variability or de novo (new) development

While you should not hesitate to take action if your child exhibits a concerning skin lesion, there is no need to panic: there are a variety of relatively non-serious medical conditions - such as pyogenic granuloma (a small, red, oozing and bleeding bump), molluscum contagiosum or warts (skin infections caused by viruses) - that can appear as a new, growing bump.

Risk factors in children and teens

Certain factors place some kids at higher risk than others. Risk factors include:

  • Fair skin, blue eyes and blond or red hair

  • Freckled or easily sunburned skin

  • Multiple abnormal moles, or a giant congenital mole on the body

  • A history of organ transplantation, certain genetic disorders (such as xeroderma pigmentosum or albinism), or illnesses/medications that can suppress the immune system

  • A past blistering sunburn (even one during childhood or adolescence can nearly double a person's chance of developing melanoma)

  • Close blood relative with history of melanoma (siblings or parents)

What you can do

Parents have more options than they may realize when it comes to protecting their children from the potentially harmful effects of the sun and indoor tanning booths. Consider the following precautions, and always speak with your pediatrician or dermatologist about any concerns you may have:

  • When scheduling outdoor time, aim for earlier than 10 a.m. or later than 2 p.m. to avoid the most potent sunrays. If your shadow is shorter than you are, seek shade.

  • Think about sun protection with every outdoor activity - not just the pool or the beach. Skin can burn while playing sports, standing in line at the amusement park or waterpark or just playing in the backyard.

  • Dress your child in light, sun-protective clothing (long sleeves or a rash guard and pants), a floppy hat that covers his or her ears and UV-protection sunglasses.

  • For children older than six months, use a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher. Reapply every 90 minutes to two hours. If you are concerned about certain chemicals contained in some sunscreens, I recommend a sunblock with zinc oxide or titanium dioxide instead.

  • For infants under six months, sunscreen is not FDA-approved; babies should wear a hat and stay in the shade of a tree or stroller canopy.

  • Use enough sunscreen. Adults must apply one ounce (the equivalent of a shot glass) to the exposed areas of their bodies; adjust this amount for your child's size and apply 15 minutes before going out.

  • Eat a healthy diet that includes foods naturally rich in vitamin D or take vitamin D supplements. You do not have to expose your child to prolonged UV radiation from the sun in order to get adequate vitamin D.

  • If your teen must have a "tan," I suggest sunless tanners, bronzer lotions, makeup or spray-on tans. There are plenty of good ones that won't make them look orange and are healthier than exposure to harmful radiation from a tanning booth.

  • Many states already prohibit children under 18 from using indoor tanning beds and others require parental permission. Check your state's requirements and talk to your teens about the dangers involved. Help protect them by strongly discouraging indoor tanning.

  • Do regular body and scalp checks looking for new or changing bumps/moles.

Parents are a major influence on their children when it comes to sun safety, and whether that's a plus or a minus depends on the situation. When parents tan, kids will often follow in their footsteps; it's hard to tell your child "no" when you're doing it yourself, and parents are more likely to sign their kids in at the salon when they're regulars, too. But on the flip side, when parents establish melanoma-preventive habits early on, kids tend to carry on the tradition, whether that means using sunblock, covering up with sun-protective clothing or avoiding prolonged time in the sun altogether.

The bottom line is that you can have fun in the sun and maintain a healthy appearance, while still being smart. By starting healthy skin care habits early with your children, you can help prevent skin cancer all the way through the teenage and adult years.

For guidelines to prevent skin cancer, visit cdc.gov.

For a powerful 60-second video produced by the American Academy of Dermatology, which warns young women that tanning - indoors or out - can have scary consequences in the future, watch "Arms." youtube.com/watch?v=usA70a5opug


Dr. Dakara Rucker Wright is a practicing dermatologist at Kaiser Permanente's South Baltimore County and Capitol Hill Medical Centers. She is board-certified in dermatology and pediatric dermatology. She completed her pediatric internship at New Jersey Medical School in Newark, NJ, her dermatology residency at Henry Ford Hospital in Detroit, MI and her pediatric dermatology fellowship at Johns Hopkins Hospital.