Question: My nine-year-old daughter has a few birthmarks on her head. She has blond hair and not much of it, and refuses to wear a hat in the sun. We are going abroad for a few weeks soon and I am really concerned about her risk of skin cancer. Do scalp moles develop into melanoma? Is it okay if she goes without a hat? Would sunscreen on her scalp help? I’ll do my best to get her to wear a hat, but I’m not counting my chances.
dr Grant replies: Melanoma is the most dangerous type of skin cancer. It is the fourth most common cancer in Ireland and its incidence increases with age. The majority of melanomas that occur on the skin (as they can occur elsewhere) begin as slow-growing tumors that are confined to the epidermis (top visible layer of skin), where they remain for several years.
Superficial spreading melanoma is the most common subtype, accounting for about 70 percent of all malignant melanomas. About 30 percent of superficially spreading melanomas are found in association with a pre-existing nevus (birthmark), such as a a dysplastic or congenital nevus, while the majority seem to start over. Superficial spreading melanoma is the subtype most likely to be associated with a pre-existing nevus (birthmark).
The revised Glasgow seven point checklist was developed in the UK to assist in setting dermatology referral guidelines for healthcare professionals working in primary care. Each major feature is assigned a score of 2, while each minor feature is assigned a score of 1. The presence of a major feature plus a minor feature or at least three minor features is indicative of a referral.
• Resize/new lesion
• Shape change/irregular edge
• Color change/irregular pigmentation
• Diameter 7mm
• Crusting or bleeding
• Sensory change/itching
Diagnosing melanoma in children is challenging because it is very rare and often presents atypically. Birthmarks are present in almost all children, and even a birthmark on the scalp can develop into melanoma.
The general practice of “safe sun” behavior should be encouraged from an early age. All family members should wear sun hats and sunglasses that are as large as possible when outdoors. Children will mimic your behavior and usually aim to please their parents.
Give her a choice of hats to match her outfit. She can choose to stay inside or go outside and play with a hat. Ideally, avoid going outside during high UV light exposure – between 10 a.m. and 2 p.m. Seek out the shadows as much as possible.
Pay particular attention to UV protective clothing when swimming. Consider having two sets per person, as children often take them off when they get wet because their body temperature drops despite the warm weather.
The recommended sunscreen is SPF 30+ with high UVA protection and is ‘mineral based’ and contains Zinc Oxide and Titanium Dioxide which form a physical barrier against the harmful UV rays. Remember to reapply sunscreen every hour. Sun protection should be all year round and not just on vacation abroad.
dr Jennifer Grant is a GP at Beacon HealthCheck
https://www.independent.ie/life/health-wellbeing/health-features/ask-the-doctor-will-the-moles-on-my-childs-head-be-a-risk-in-the-sun-on-our-holiday-abroad-41605899.html Ask the doctor: are the birthmarks on my child’s head a risk on our vacation abroad in the sun?