Childhood is when a lot of moles (nevi) first appear, and parents are understandably unsure of what is normal. There are many different types of moles.
A set of rules to assess moles for melanoma risk in adults and older children is the “ABCDE” rule. Not every mole that meets one or more of these criteria is worrisome, but moles that meet the ABCDE criteria deserve to be checked:
ABCDE rule for moles
- A: Asymmetry- this describes moles that don’t look the same on both sides if you imagine dividing them in half
- B: Border irregularity- a border with notches or an irregular outline
- C: Colour variation- moles with more than one colour
- D: Diameter greater than 6mm-the size of a pink eraser on the tip of a pencil
- E: Evolution- a mole that is changing rapidly, for example from one month to the next, or changing differently or faster than other moles.
A modified ABCD rule was developed for pre-pubertal children (10 and younger) in 2013, as melanoma can present differently in this age group and can be missed by the traditional ABCDE above:
- A: Amelanotic- the bump is not pigmented (brown or black), but is skin-coloured, pink or red
- B: Bleeding, Bump- a new, non-resolving bump or bleeding skin lesion
- C: Colour uniformity- whereas in adults and older children multiple colours are a warning sign, early childhood melanomas can be a single colour
- D: De novo, any Diameter- a new lesion, not necessarily larger than 6mm
Evolution remains an important feature- most childhood melanomas present as rapidly growing.
Some helpful hints for managing your child’s moles
- Avoid sun exposure- ultraviolet (UV) exposure, both with and without sunburn, is linked with the development of more moles. We also know that the sun can cause changes in moles that can lead to melanoma.
- Know your child’s moles. Bath time is a good time to look these over.
- Watch for change: moles do change throughout childhood- they can grow larger, and sometimes become more bumpy. These changes usually happen slowly over the course of years, and happen similarly in multiple moles.
- A mole that is changing faster than others, or meets any of the ABCD criteria, should be checked by your doctor. Melanoma is very rare in children, but sadly the incidence is not zero, so it is best to be safe.
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This article is intended to provide general information and is not intended as a substitute for assessment and care from your doctor.