Melanie Cole, MS (Host): Welcome to Long Live Childhood, a pediatric health and wellness podcast presented by Children's Health of Orange County. I'm Melanie Cole. And joining me today is Dr. Shireen Guide. She's a board-certified pediatric dermatologist with Children's Health of Orange County, and she's here today to tell us about moles in children. Dr. Guide, thank you so much for joining us today. Is it normal for kids to have moles?

Dr Shireen Guide: Absolutely. And it's an honor to be here. So generally, most kids do get moles in the first two decades of life. It's completely normal. Depending on your skin color and ethnic group, you know, moles can look different. Some can be lighter, some can be darker. There's different variations of moles. And moles are considered normal and healthy. But there are certain types of skin cancer that actually can come from moles. So, that's one of the things that we do want to educate parents and kids about looking for abnormal moles and what to look for.

Melanie Cole, MS: Well then, let's do that. So first of all, what age are we talking about? Is it sort of any age? Are we excluding our littler kiddos? What age should we worry about moles and how do we know as parents if a mole needs to be checked?

Dr Shireen Guide: So, it is normal for newborns to have moles and sometimes they actually are born with these moles. These are called congenital moles when they appear within the first year or so of life. And there's specific features that we see under the microscope when we look at these type of moles. Sometimes later on, these type of moles can then elevate, especially during puberty, and may thicken or become a little bit bigger, and often will grow a hair, which can be a very healthy sign in a congenital mole. And these are some of the kind of questions that we get from parents all the time.

So, moles develop really the first two decades. And again, there may be different types of moles. Generally, we use the same acronym or mnemonic that we use for adults, and that's called the ABCDEs. And we use that acronym to look for irregularities in moles or abnormalities in moles that can be a sign of an atypical mole or a mole that has features of melanoma, which is that concerning type of skin cancer that can come from mole cells or melanocytes.

A stands for asymmetry. So if you cut a mole in half, the idea is that the sides should match. The mole should be symmetric. B is for borders. So, moles should really have a very distinct border. A mole with an irregular border or a blurry border might be a sign that it's not completely normal. C is for color. So, some moles may be darker, some might be lighter, but we do like the moles to have the same color throughout. And then, D is for diameter. So, Moles that are larger than 5 mm are moles that we want to really think about, "Okay, has this mole been changing? Has it gotten larger rapidly? Or has this mole been relatively stable?" It is normal to have larger moles. And some kids are born with these larger type of congenital moles. But the main thing is that these moles are not rapidly changing, growing, itching, any kind of abnormalities that make us concerned that this might be something atypical or abnormal. And then, the last letter in that ABCDE is E for evolving. And this is really the most important one because any mole that is changing, we talked about in either size, shape, or color, or even itching, grows, or even bleeds. Sometimes people may come in and say, you know, "This mole bled, but I don't remember scratching it." So, that might be a sign that something is concerning and needs to be checked.

Melanie Cole, MS: Dr. Guide, if there's a family history of skin cancer, or melanoma specifically, when should parents take their kids in for a first mole check?

Dr Shireen Guide: So, this is a common question because parents that have had melanoma in their families are definitely more concerned and have a heightened awareness of this issue. In general, melanoma does have a high genetic predisposition. So, kids that have a family history of melanoma are twice as likely to develop a melanoma in their lifetime. However, melanoma is exceedingly rare in kids. So in kids under 15, the incidence of melanoma is around 1 in a million. So, it's extremely low. And that's compared to our adult incidence which is 1 in 40 in Caucasians, maybe around 1 in 200 in some darker skin types. So, there's a big difference.

So, I generally recommend either monitoring in conjunction with a pediatrician. And then around 16 or so, that teenage age when kids stop listening to their parents, is a good time to go into the dermatologist. Talk to the kids about sun protection, about regular exams, and talk to the kids. Because at that age, they're going to be able to do self-exams, start to look for some of these things. And that way, they'll be aware of looking for any abnormalities and when they need to follow up with the doctor.

Melanie Cole, MS: Dr. Guide, I always wondered, can a childhood mole turn into cancer? So if they've got some benign something that they had at two years old, and then you say at 16 they're doing their self-checks, and they're starting to become a little bit more aware of things, can some of those moles turn into something worse?

Dr Shireen Guide: So yes, again, there are some normal changes that we see in moles, especially around puberty. So, that is a common time parents will bring their kids in because the moles are elevating or you can see hairs or they darken or thicken. This was some of the normal changes, but moles can change. And as the cells change, you would see similar changes clinically with your eyes. So, those kind of changes would be, again, sometimes they're just textural changes, sometimes they might be color changes, so we look for things that have multiple colors. Again, the mole might start to grow a tail or a little edge that wasn't there previously.

Even earlier on, the congenital moles can change at any point. Obviously when they're little, it's much more rarer. And then as they get older and their risk increases, then there's a higher chance of developing. Probably about 25-50% of melanomas develop from pre-existing moles, and then the other half are actually new spots that develop.

So, what I generally tell parents is that when a mole pops up, it should kind of pop up and then be relatively stable. You don't want to see a mole that's like rapidly changing. And there are some unique variants in kids that we can see that are abnormal. So generally, parents bring their kids in right away with these type of moles because they look different than the other moles. The other term that I really like is the ugly duckling rule. And that means that most kids and most individuals form the same type of moles. So if all your moles have a little dot in them at 12 o'clock, then I'm pretty reassured because all those moles are similar appearing and look the same. So, we look for the ones that are different from the other ones, right? The ugly ducklings. So, that's often a really good rule for kids and for parents when monitoring their moles.

Melanie Cole, MS: As we wrap up, and this is really important because so many parents kind of freak out when they start to see various skin tags and moles. Tell us what you would like us to know as a pediatric dermatologist about keeping healthy skin, about those tags, moles, skin cancer, keeping our children protected from all of these things.

Dr Shireen Guide: Well, I do have a lot of parents that ask me, you know, "Can I prevent my kid from getting moles?" And some of these moles are really pre-programmed. You know, your aunt had a mole on the finger and everyone in the family has a mole in that spot, then chances are we're not going to be able to prevent that mole.

But there are a lot of moles that are triggered in response to sunlight or sun exposure. So, it's really important that kids at a young age are protected with rash guards, protective clothing, hats, sunscreen. And most importantly is reapplication of sunscreen. Because it doesn't matter what you put on at 8:00; by noon, it's gone. So really, that's an important thing that we always drive home with parents and with kids, is that they really need to reapply.

Another thing that I always hear from parents is that we're not going to get enough vitamin D if we don't get enough sun. And really, both the American Academy of Pediatrics and the American Academy of Dermatology really encourages that the vitamin D should be obtained from diet or supplementation and not necessarily through sun exposure. So, that's something also to consider.

Melanie Cole, MS: Wow, this is such good advice. Dr. Guide, thank you so much for joining us today and telling us about those A, B, C, D, E's and what we're looking for as parents and when we should bring our children in to get checked for moles. That was just great advice. Thank you again for joining us. And for more pediatric health and wellness tips, you can visit choc.org. Thank you so much for listening to Long Live Childhood, a pediatric health and wellness podcast presented by Children's Health of Orange County. Together, we can keep kids happy and healthy. And please remember to share on your social channels as we're all learning from the experts at CHOC Together. I'm Melanie Cole. Thanks so much for joining us today.