Diagnose Pediatric Melanoma Using the CUP Criteria

It is typically perceived that cutaneous malignancies in childhood and adolescence are uncommon, but the incidence of melanoma in this patient population is increasing. In 2014, the American Cancer Society estimated 310 cases of malignant melanoma in adolescents aged 15 to 19 years, making it the 8th most prevalent cancer in adolescents. Based on US data for pediatric patients aged 0 to 19 years (2006-2010), melanoma was reported to be more common in girls and non-Hispanic whites. For pediatric cases diagnosed in 2003-2009, the 5-year observed survival rate was 95%, an increase from 83% in 1975-1979. These findings serve as a reminder for practitioners to encourage young patients to practice good sun protection habits. Even if patients are careful, melanomas do occur in childhood and early diagnosis is key.

The ABCDE—asymmetry, border irregularity, color variegation, diameter, evolving—criteria have been used for melanoma screening in adults and may be helpful in detecting pediatric melanoma. However, Silverberg and McCuaig proposed a mnemonic specifically for screening children called the CUP criteria. Because melanomas of childhood do not necessarily arise in a preexisting nevus, the CUP criteria take into account melanomas that arise de novo and may present histologically as spitzoid neoplasms. The atypical presentation of melanomas in childhood includes color uniformity (pink/red), ulceration and upward thickening, and pyogenic granuloma–like lesions and pop-up of new lesions.

For more information on practice modifications from these screening criteria for pediatric melanoma, read Silverberg and McCuaig’s Cutis article “Melanoma in Childhood: Changing Our Mind-set.”