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Pediatric Melanoma Diagnosis

How is Pediatric Melanoma Diagnosed?

A proper diagnosis is essential for selecting the best treatment. The diagnosis of skin melanoma can only be made with a biopsy, which is then examined under a microscope by a pathologist. Pathologists who specialize in looking at skin biopsies are called dermatopathologists, but even board-certified dermatopathologists may not have extensive expertise in recognizing melanoma in children. In addition, even expert dermatopathologists sometimes disagree about the classification of a child’s mole as benign, atypical or malignant.

 

It is important to be sure that an expert dermatopathologist has looked at your child’s biopsy, and you especially need to know if there is some degree of uncertainty about whether the mole is benign, atypical or malignant. Because pediatric melanoma is difficult to diagnose, the diagnosis can sometimes be delayed or misdiagnosed. Most doctors don’t expect it, and some types of pediatric melanoma look different than adult melanoma.

Pediatric & AYA Treatment

Pediatric Melanoma Diagnosis

How is Pediatric Melanoma Diagnosed?

Sometimes pediatric melanoma is misdiagnosed as pyogenic granulomas, atypical melanocytic neoplasms, warts or Spitz nevi. Spitzoid melanoma, in particular, can look very similar to benign Spiz nevi, which makes diagnosis even more challenging. In these cases, doctors may use additional tools such as immunohistochemistry (Ki-67, HMB45, p16 and PRAME) staining, or molecular testing like next-generation sequencing and CGH/FISH to help confirm the diagnosis. Non-invasive gene expression profile tests are also being studied as future tools to support diagnosis in children.

 

If the biopsy comes back as a melanoma, surgeons may perform another surgery to ensure there are clear margins – the term used for the pathologist’s assessment of complete removal of the lesion. Depending on the specifics of the diagnosis, the doctor may recommend a sentinel lymph node biopsy (see below). This will help the doctors know if the melanoma has spread beyond the primary tumor. All of this information will be included in the pathology report. The pathology report will help you understand your child’s stage of diagnosis, as well as help guide your treatment options.

 

In some cases, doctors may recommend a test called a sentinel lymph node biopsy (SLNB) to see if the melanoma has spread to nearby lymph nodes. This is more common in teens with thicker melanomas. In younger children, the benefits of this test are less clear, since even harmless moles can sometimes involve the lymph nodes. Depending on the situation, your child’s care team may also use imaging tests, such as ultrasound, CT or MRI, to check for any signs that the melanoma has spread.

 

Melanoma does not discriminate.

 

NEVER LET A DOCTOR TELL YOU THAT YOUR CHILD IS TOO YOUNG TO GET MELANOMA.

Pediatric & AYA Treatment

What Does Pediatric Melanoma Look Like?

Your child’s skin should be evaluated by a professional familiar with pediatric melanoma if you see any area with one of the following features:

  • A bump that itches and bleeds
  • A spot that looks like an unusual wart – sometimes non-pigmented or with a pinkish color
  • An amelanotic lesion – a lump on the skin that isn’t dark or black (like many adult melanomas)
  • A mole that becomes nodular – very bumpy and sticking out far from the rest of the skin
  • A lesion that presents as a nodule, or lump, especially one that has been rapidly enlarging
  • Moles that look strange or large – especially a mole that looks DIFFERENT from your child’s other moles or has more than one color

 

Although some research suggests that the ABCDEs of melanoma should be revised when using them for diagnosing melanoma in children, it is important to remember that in most cases, the E, for evolution or change, is the most important factor to consider. For younger children, specialists often use a modified checklist called “ABBCDDE” (Amelanotic, Bleeding, Bump, uniform Color, small Diameter, De novo development, and Evolution) since their melanomas don’t always follow the same ABCDE rules as adults.

 

What if I spot something suspicious?

 

Screening for melanoma starts at home. Parents should be aware of all moles that their children have so that they will notice any changes or new moles.

 

A dermatologist, preferably one who has a lot of experience in melanoma, should examine your child’s skin as soon as possible. Alternatively, you may wish to have your child examined at a pediatric pigmented lesions clinic or by a pediatric oncologist experienced in pediatric melanoma. It is important that melanoma is detected as early as possible to ensure the best outcome. Newer tools such as dermoscopy (a special lighted magnifier), digital photography to track changes over time, or even non-invasive molecular tests may also be used by specialists to evaluate suspicious lesions.

 

Check out our Kid’s Guide to Self-Screening!

Kid's Guide to Self-Screening

Content Reviewed By:

Content last updated: November 18, 2025

  1. Vernon K. Sondak, MD, Chair, Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida. Dr. Sondak specializes in the treatment of children and young adults with melanoma and atypical Spitz tumors.