Get tips on moles, freckles, melanoma (skin cancer) and when your child should see the doctor
Moles come in all sorts of shapes and sizes, and they often add unique character to an individual’s appearance. However, moles can also offer helpful clues for determining skin health.
As a parent and protector of your child, you may have questions about how to tell if a mole is normal or not, and when to seek help.
In this Q&A, Dr. Amanda Salter, a CHOC pediatrician, offers valuable advice on how to check for moles, when they might indicate skin cancer risk, and when to call the doctor.
What are moles? What do they look like?
Moles are collections of pigment cells, called melanocytes, that form a growth in the skin, says Dr. Salter.
Normal moles will usually look like each other. For example, if a child typically has oval-shaped moles or moles that are darker in the middle, then all their other moles will likely look similar. Because of this, parents should look out for moles that look different than their child’s other moles.
Are moles common in children?
Yes. It’s common for kids to get most of their moles in the first two decades of their lives, and then fewer every decade after. Depending on your child’s ethnic background, they may have a different number of moles than other kids.
It’s normal for moles to develop hair, thicken, darken or get bigger. These changes can be caused by age, puberty and hormone changes such as pregnancy or puberty, says Dr. Salter.
What are the differences between moles and freckles?
Freckles are pigmentation (coloring) of the base of the epidermis (top layer of the skin). Dr. Salter says that freckles typically develop in response to sun exposure or ultraviolet radiation, like tanning beds.
Moles are collections of pigment cells, called melanocytes, that form a growth in the skin.
Since both freckles and moles can be flat, it may be difficult for parents to tell the difference between a mole and a freckle, says Dr. Salter.
Physicians can evaluate these lesions with a handheld microscope — called as a dermatoscope — which allows them to see mole patterns through magnification and polarization of the light. This allows the doctor to evaluate and determine if there are suspicious features to warrant further evaluation in the form of a skin biopsy or removal.
Both freckles and moles can be minimized through good sun protection, including:
- rash guards;
- protective clothing;
- hats;
- sunscreen; and
- remembering to reapply sunscreen every 90 minutes – and more frequently if in the water or with excessive sweating.
Get more sun safety tips from CHOC.
Are freckles a sign of skin cancer in kids?
No. Freckles have no inherent cancer risk since they are merely increased color at the base of the skin and cannot turn into skin cancer, says Dr. Salter.
But, if a child has a lot of freckling in a specific area, such as shoulders or face, it can be a sign of excessive sun exposure which can lead to skin cancer later in life.
There are also rare genetic syndromes that cause freckling in certain areas. If your child has freckles in areas that the sun wouldn’t reach like under the arms or in private areas, check in with your doctor.
Are moles a sign of skin cancer in kids?
Common moles are rarely cancerous, but some irregular moles may be a sign of melanoma or other skin cancers. Children generally do not get basal cell or squamous cell cancers, which are the most common skin cancers in adults.
Melanoma is extremely rare in the pediatric population. The National Cancer Institute offers the following statistics on the frequency of melanoma diagnoses in kids:
- In kids younger than age 15: One in 1 million.
- In females ages 15 to 19: Ten in 1 million.
- In males ages 15 to 19: Five in 1 million.
Do moles look different on different skin colors?
Yes. Often, darker-skinned people can have darker moles. These moles may also thicken and darken more during puberty.
If the child tends to have more hair on other parts of the body, then they may be more likely to develop moles with more hair – especially in larger moles that kids have from birth.
Can I check my child for moles at home? How often should I do so?
Yes. Parents can check their kids monthly or every couple of months. When doing so, make sure to take note of the ABCDEs of melanoma screening and surveillance on all areas of their bodies — including private areas and scalp.
Once your child gets older, you can pass the monitoring to them. Educate your child on the ABCDEs of melanoma, and make sure they know how important it is to self-monitor for moles.
What to look for: The ABCDEs of Melanoma
A is for asymmetry
If you cut the mole in half, the sides should match, and the mole should be symmetric.
B is for borders
A spot with irregular, scalloped or blurry borders.
C is for color
The spot has varying colors from one area to the next, such as shades of tan, brown or black, or areas of white, red or blue.
D is for diameter
Melanomas are typically larger than 5mm, or the size of a pencil eraser, when diagnosed, but they can also be smaller.
Individuals may have larger moles that are not concerning but if their large moles are changing and getting larger, they may warrant further evaluation by a healthcare provider.
E is for evolving
Any mole that changes in size, shape or color or begins itching or bleeding may warrant further evaluation by a physician.
When should you call the doctor?
Follow the ABCDE rule, advises Dr. Salter. It’s a good guide for parents to look out for anything that looks unusual or is rapidly changing or causing symptoms like itching or bleeding.
If you spot any of the ABCDEs, contact your pediatrician or dermatologist for a checkup.
What is the typical treatment for moles?
It’s generally OK to leave normal moles alone unless they cause problems, explains Dr. Salter. For unusual moles, some may be watched, while others with a higher risk of turning into skin cancer are usually removed surgically.
Cosmetic mole removal surgeries are common, but families need to consider the potential scarring of the mole removal area and the high likelihood that the mole will reappear and increase in size. Families should include their child in the decision to cosmetically remove moles.
Can I prevent my child from getting moles?
Only some moles can be prevented. Moles caused by sun exposure can be prevented with sun safety measures like rash guards, clothing and hats.
Other moles are congenital (something that kids are born with) or they run in families. It’s common for family members to have moles in the same spot.
How can kids get enough vitamin D if they are using sun protection?
It only takes 15 to 30 minutes in the sun for kids to get their daily dose of vitamin D — so kids who live in sunny places like California should be getting all the vitamin D they need in their daily routines.
For kids who may be deficient in vitamin D, or who live in less sunny places, the American Academy of Pediatrics (AAP) recommends that kids get their vitamin D from their diet or through supplements, rather than from the sun.
Are there unusual moles that kids can get that aren’t related to skin cancer?
Yes. There are normal types of moles that may look unusual — like two-tone (or two-color) moles or eclipse moles (moles that have a dark center and lighter rim or a lighter center and darker rim).
These types of moles are often found on the scalp of fairer-skinned people, says Dr. Salter.
Some rare types of moles — called Spitz Nevus — may also develop in kids. These tend to be pink and dome-shaped or sometimes black in a starburst pattern. These moles are usually non-cancerous but sometimes require removal.
If you notice an unusual-looking mole on your child, reach out to your pediatrician. They may refer you to a dermatologist.
Are some kids more at risk of getting cancerous moles than others?
Yes. The same rules of melanoma risk apply to kids as adults. Family history of melanoma, history of blistering sunburns, excessive sun exposure, fair skin, living in sunnier climates and ultraviolent radiation from tanning salons may increase the risk of developing skin cancer.
Fortunately, due to regulations restricting tanning bed use in minors and a shift in attitudes about embracing diverse skin tones, tanning beds are now much less popular than in past years.
Now, there are many safe and natural-looking moisturizers and self-tanning creams that kids and teens can use for a sun-kissed glow, says Dr. Salter.
If my child has darker skin, are they still at risk for skin cancer?
Yes. Melanoma is usually genetic, and patients with darker skin can still get melanoma.
Because of the misconception that only fairer-skinned people can get skin cancer, darker-skinned people are often diagnosed at a later stage with more severe skin cancer because they are less likely to seek preventative screening and early diagnosis.
Although some moles may lead to skin cancer, most moles are normal and harmless to your kids. Use these tips to help guide mole monitoring and determine when to call the doctor. Sun safety measures are a valuable tool for preventing cancerous moles.
Remember, you know your child best, and you can help protect their skin! Just by reading this article, you are already doing great. Don’t be afraid to reach out to your pediatrician or dermatologist with any questions or concerns.
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