Melanoma on the rise

Chicago - There has been a significant increase in the incidence of melanoma in children.

Annette Wagner, M.D., says this is one of her major concerns as a dermatologic surgeon.

"Though it's still a small percentage of the overall skin conditions in the pediatric population, melanoma is increasing with great frequency in children, as well as adults," says Dr. Wagner, assistant professor of pediatrics and dermatology at Northwestern University's Feinberg School of Medicine. "Treating children with melanoma is one of my biggest challenges."

One contributing factor is a dilemma occasionally faced at the diagnostic stage: the challenge of distinguishing melanoma from look-alike Spitz nevi.

This distinctive variant of melanocytic nevi tends to manifest as pink papules that can be clinically indistinguishable from conventional nevi. Spitz nevi are known to be benign - but their presence poses a problem because of their potential for leading to misdiagnoses.

"The dilemma is that if they are diagnosed as melanoma, there can be overtreatment," Dr. Wagner says.

"On the other hand, if a child has a melanoma that's diagnosed as a Spitz nevus, there are serious implications there. One of my biggest clinical burdens has been dealing with this dilemma in several cases."

There may be help on the horizon that will go a long way toward resolving this diagnostic dilemma. Dr. Wagner says researchers are working on DNA technology that will allow dermatologists to distinguish Spitz nevi from melanoma.

Surgery, sutures, silicone

As for pediatric dermatologic surgery procedures, Dr. Wagner says one continuing trend relates to anesthesia.

"The trend in surgery in pediatric cases has always been to accomplish what we need to accomplish by using local anesthesia rather than general anesthesia, which is typical in similar surgical procedures done on adults," she says.

Dr. Wagner says she's also seeing a continuing trend toward double excisions in pediatric dermatologic surgery.

"With two excisions at one time, we can remove much larger lesions and birthmarks because children's skin has much more elasticity," she tells Dermatology Times. "We can remove as much as 70 to 80 percent of a large lesion in the first surgery, then go back and remove the rest a couple of months later.

"There's also a trend toward using the purse-string suture technique to close after excision surgeries," Dr. Wagner adds. "This technique preserves tissue and reduces scarring."

Dr. Wagner says that postoperatively, she's using - and seeing more postoperative use of in general - silicon gel sheeting to expedite healing in pediatric surgical procedures.

"Kids' scars stay redder and don't heal as quickly, because kids are so physically active," she says. "The silicon gel sheeting applies pressure to the scar and reduces fibroblast activity, thus decreasing any overgrowth of scar tissue."

Dr. Wagner reports that studies are showing silicon gel sheeting to be very effective in healing postoperative scars.