As noted above, pediatric melanoma is not just one disease, it most often falls into three main categories:

• Conventional Melanoma (CM): This type is most common in teens and is rarely seen before puberty. Clinically, CM in younger patients shows several similarities to adult melanoma, including evidence of UV-induced DNA damage and similar UV-induced mutations (such as the BRAF mutation). It often occurs in patients with multiple atypical moles.
• Spitzoid Melanoma (SM): Spitzoid Melanomas often appear as round, raised bumps that may be pink, red, or skin-colored rather than dark. Therefore, SM does not typically follow the commonly used ABCDE guide to diagnosing melanoma. The term Spitzoid means that the lesion looks somewhat like a Spitz nevus, a kind of benign mole first discovered in 1948 by Sophie Spitz, when examined under the microscope. SMs were described as “melanomas of childhood”. Today we know they can occur in both children and young adults. Importantly, as our understanding of the genetics of melanoma and Spitz nevi has increased, we now realize that only some Spitzoid tumors are actually genetically related to Spitz nevi. Some Spitzoid melanomas, when their molecular makeup is analyzed, turn out to be conventional melanomas that simply have a Spitz-like appearance under the microscope. These Spitzoid melanomas have standard melanoma mutations like BRAF or NRAS mutations and are treated just like CM. True Spitz lesions have a different genetic makeup, and lack BRAF or NRAS mutations, but may have HRAS mutations or unusual fusion genes. When a melanoma that has a Spitzoid microscopic appearance is found to have a genetic makeup consistent with a Spitz tumor, it is called a “Spitz melanoma” and presumably represents a Spitz nevus that has turned malignant. One particular issue with Spitz tumors is that it can be hard for even experienced pathologists to tell which ones are truly melanomas and which ones are atypical but not definitely cancerous. So many Spitz lesions that are too atypical to call a benign Spitz nevus but can’t be clearly classified as melanoma receive the name atypical Spitz tumor (AST) or Spitz tumor of uncertain malignant potential (STUMP).
• Melanoma arising in a Congenital Melanocytic Nevus (CNM): A CNM is a large, pigmented mole or birthmark that is present at birth. Most never become cancerous, but very large or giant CMN carry a higher risk of developing melanoma. Current research suggests approximately 5-10% of CNM cases develop into melanoma.

Ocular melanoma and mucosal melanoma are rare forms of the disease and although uncommon, can also occur in children.

Adolescent and young adult, or AYA, melanoma refers to someone diagnosed with melanoma between the ages of 15-39. According to the National Cancer Institute, about 70,000 young people (ages 15-39) are diagnosed with cancer each year in the United States – accounting for about 5% of cancer diagnoses in the U.S. Melanoma is one of the most common cancers seen in AYAs. Unfortunately, survival rates for AYAs have not improved as much as they have for children or older adults.

To address this, many cancer centers now have special programs designed for AYAs. These programs help patients and families manage the emotional toll of a diagnosis, gain access to clinical trials, understand treatment and possible fertility risks and options, and connect with others who are facing similar issues.

In addition to the cancer-specific differences, AYA patients often have less access to clinical trials and are provided with insufficient age-appropriate psychosocial support and health services. Improving access to these services may influence survival as well as overall quality of life.

Of great concern is the fact that the incidence of melanoma is largely preventable yet continues to increase in the AYA population. An estimated 75% of melanomas diagnosed in people younger than 30 years of age appear to be linked to exposure to natural or artificial UV radiation, such as tanning beds. More must be done to protect skin health, reduce the rate of melanoma diagnoses and increase awareness of melanoma.

Because melanoma is a relatively rare diagnosis, it is important for AYA patients to find an oncologist who specializes in treating melanoma. Getting a second opinion may be especially helpful when complicated medical decisions need to be made or if there are different treatment options to choose from and should always be considered if there is uncertainty about the diagnosis or whether the mole is benign or malignant.