Updated May 9, 2018

One of the fastest growing cancers among adults, skin cancer is becoming increasingly prevalent in children and teens, too. Yet, it is also one of the most preventable cancers. Proper, protective skin care, especially in the summer months, can help prevent its development in childhood, and subsequently in adulthood. That tan you might think is healthy – even a rite of childhood – is evidence, already, of DNA damage. Johns Hopkins pediatric dermatologist Annie Grossberg addresses some of the issues.

What causes skin cancer?

Skin cancer is caused by mutations, or errors, in the DNA of skin cells. These mutations permit the cells to grow in an uncontrolled way and result in the development of cancerous moles or other growths on the skin. Much of this DNA damage to our skin cells is caused by ultraviolent (UV) radiation, either from the sun or from tanning beds. Fortunately, the body is constantly working to keep these mutations in check. But when it’s unsuccessful, cells can multiply rapidly and form malignant tumors.  There are three main types of skin cancer—basal cell carcinoma, squamous cell carcinoma and melanoma—and the type that develops depends on the type of skin cell from which the cancer originates. Melanoma is the most feared because it is more likely than the other types to spread to other body parts where it can damage organs and even result in death.  

For generations, children have played in the sun. What has changed?

We do not understand fully all of the reasons behind the increasing incidence of melanoma in children and adolescents. However, one very significant modern factor appears to be exposure of teens and even younger children to tanning booths. Pre-teens and adolescents are increasingly modeling adult behavior and experimenting with tanning booths. As the cases of skin cancers in the young trend upwards, we also are getting better at identifying these cases. 

As a pediatric dermatologist, what do you look for?

We are trained in the ABCDEs of detecting potentially cancerous moles—Asymmetry, Border irregularity, Color variation, Diameter over 6 millimeters (or the size of a #2 pencil eraser), and Evolution, or change over time—to identify which moles (nevi) might require biopsy or removal to test for skin cancer. As it turns out, however, while some skin cancers in children may be detected in this manner, melanomas in children may look entirely different, and not even like a mole at all. In children, melanoma may be more likely to present as a new growing bump on the skin that may appear red, pink, or lack color entirely. This bump may bleed, another cause for concern.

Can skin cancer be prevented?

Yes, in many instances. Although sun exposure is, strictly speaking, not the only contributing factor, it is a chief one. Because skin cancer can often be effectively treated if caught early, we ask pediatricians to include conversations with parents and children about proper skin protection at their well child visits. We teach children and teenagers what to look for, including how to spot potential pre-cancers or cancers. Parents should keep an eye on the skin of younger children by doing skin checks at home. Keep a look out for what we call the “ugly duckling”—a mole that looks very different from the child’s other moles, or a mole that begins changing in a way that other moles are not.

How can parents protect their children?

First, they should model good sun protection at all times while outdoors and avoid tanning beds, which likely are contributing to the rise of melanoma in kids. Babies under the age of 6 months should be shielded from the sun with blankets, hats and sun shades. For children older than 6 months of age, sunscreen should be applied liberally to all exposed surfaces and reapplied at a minimum every 2 hours, but sooner after swimming or other water or sweat exposure. In general, children should be kept out of the sun as much as possible between the hours of 11 a.m. and 4 p.m. and wear sun-protective clothing, including a hat. I love rash guards and other sun protective clothing because they provide a consistent amount of sun protection without the need to reapply sunscreen to those covered areas, which any parent knows can be a challenge no matter the age of the child.

What about protective eyewear?

Absolutely. Because skin cancers, including melanoma, can affect the eyelids as well as parts of the eye itself, use of protective sunglasses outdoors is always a good idea. 

What should we look for in a sunscreen in children over 6-months-of-age?

Sunscreens for children should be a broad spectrum formula with protection from both UVA and UVB radiation. New regulations require manufacturers to note whether a product protects against both of these subtypes of ultraviolet radiation, and a product labeled “broad spectrum” is what I recommend. Although the specific sun protection factor (SPF) number needed varies by the individual, I often recommend at least SPF 30 for daily protection, and often higher for those skin types more prone to burning or if there are other risk factors for skin cancer. I recommend a good coat of sunscreen on children before they go outside, no matter the season, and even when it is overcast. Even on overcast days, abundant harmful ultraviolet rays are present. Be sure to reapply every two hours or sooner if your child has been swimming or sweating. I am often asked about the use of spray sunscreens. My preference is to use a cream or lotion, as sprays may not consistently deliver the dose of sunscreen necessary. As with other aerosol products, inhalation may pose risks to children that are not fully known at this time. Certainly, for small children, creams and lotions are still considered safest and most effective.

What about clothing?

Shirts, hats, and other clothing with a UPF (ultraviolet protection factor) label have built-in sun protection. But don’t forget that even clothing with a high UPF does not replace sunscreen, as several areas will often be uncovered, including the face, hands, feet, and back of kids’ necks. 

But isn’t sunlight a vital form of Vitamin D?

Sunlight is a major source of Vitamin D, which is essential to the health of our bones and immune system. But there are other sources of Vitamin D besides sunlight, including diets rich in fish, fortified dairy products and cereals, as well as supplements.  

Other than skin cancer, does sun exposure carry other risks?

Premature skin aging, such as fine lines and wrinkles, as well as some discolorations, are often the result of sun exposure that starts early in life. For teens, have a discussion about the importance of sun protection early on. While the risks of skin cancer may not seem relevant to them, the prevention of skin aging might.

What is your take-away message for parents?

Limiting exposure to sunlight in children and teens may pay large dividends later in life. Research has shown that sunburns early in life increase a child's risk for skin cancer later in adulthood. In young children, parents can set the tone by instituting good routines of sunscreen application and use of sun protective clothing early in life. Finally, if you are concerned about a spot on your child’s skin, come in and have it checked out. When caught early, skin cancer is often curable.

An assistant professor of pediatric dermatology at Johns Hopkins, Dr. Grossberg sees patients in the pediatric dermatology clinic at Johns Hopkins Children’s Center as well as at Green Spring Station. For more information or to schedule an appointment, call 410-955-5933