Kids develop all sorts of bumps, spots, blisters, burns and rashes. Many of these marks may have parents wondering if their child needs to see a dermatologist, or if they should take a wait-and-see approach.
On top of that, parents who visit the dermatologist regularly to get their entire body checked for melanoma may worry that their kids need to be screened too. A new freckle that appears out of nowhere or a mole that is growing bigger can send vigilant parents into panic mode.
Yet pediatric dermatologists can be hard to find, and most children never set foot in a dermatologist’s office. Does that mean parents don't need to worry about it? Here's what experts say.
Do kids need to see a dermatologist?
Most healthy children do not need to see a dermatologist for routine skin checks, Dr. Christopher Bunick, associate professor of dermatology at Yale School of Medicine, tells Yahoo Life. That’s because the risk of skin cancer in children under 13 is “exceptionally low,” he explains. However, If parents want to get their children screened for peace of mind, Bunick says bringing them in for a check every two years is “reasonable.”
What if there's a specific skin concern?
Even when a child develops an issue with their skin, like a rash, they still may not need to be evaluated by a dermatologist. “Many common, uncomplicated conditions can often be addressed by a pediatrician,” Dr. Erina Lie, a pediatric dermatologist with Kaiser Permanente in San Francisco, tells Yahoo Life.
Bunick emphasizes that “pediatricians are skilled in identifying children who may benefit from seeing a dermatologist." Therefore parents should feel confident consulting their pediatrician about any skin concerns before heading to the dermatologist.
Should freckles and moles be checked out?
It’s natural to worry about skin cancer when new moles and freckles appear on a child’s skin. But this isn’t usually cause for alarm. “It is normal for children to develop new moles and for their existing moles to change with their growth,” Lie says.
But that doesn’t mean kids never need to get checked for skin cancer. Lie explains that most pediatricians perform a skin check as part of a child’s annual check-up. She also recommends that parents look at their children periodically for signs of skin cancer, about every three to six months.
If parents notice a “concerning change in any skin lesion,” they should get it evaluated, Bunick says. Specifically, he recommends that parents pay attention to the ABCDEs of moles, or their asymmetry, border, color, diameter and evolution. These are the five characteristics dermatologists evaluate to determine if a mole might be cause for concern.
If a freckle or mole has become asymmetric in appearance, the border or color has changed, the mole has gotten bigger or if it starts itching, bleeding or causing pain, it’s time to head to the dermatologist. When it comes to color and size, moles that turn blue, red, black or white, or that grow to more than 6 millimeters, about the size of a pencil eraser, are especially concerning, Dr. Allison Zarbo, a pediatric dermatologist with Henry Ford Health in Detroit, tells Yahoo Life. Borders that are jagged or that blend into the skin may also indicate a problem, Lie adds.
A child may also need to be seen by a dermatologist if they develop an “ugly duckling.” This is a mole or freckle that looks different from what is normal for them, even if it doesn’t have other concerning characteristics, Lie says.
What risk factors should parents consider?
In the event a child has a greater risk of developing skin cancer for any reason, they may need to be evaluated by a dermatologist before a problem develops. For kids with a history of skin cancer in the family, parents should be more vigilant. Bunick says that these children should be examined by a dermatologist every one to two years.
According to Zarbo, other risk factors include having more than 50 moles, getting sunburns (especially blistering ones), being immunosuppressed (due to taking medications for a transplant, for example) or having a rare genetic disorder that predisposes children to skin cancers.
Lie adds that children who have had skin cancer need to be evaluated between one and three times a year, depending on the type of skin cancer they had.
It’s worth noting that, as this 2016 report points out, people of color are less likely to have skin cancer but are significantly more likely to die from it due to "a delay in detection or presentation." Along with the misconception that darker skin isn't vulnerable to skin cancer — it is — and a general lack of medical guidance offered about protecting their skin, people of color have also reported their symptoms of melanoma being less visible, or even appearing in easily missed spots like on the soles of the feet, on fingernails or inside the mouth. Therefore sunscreen, thorough self-checks and, in the event of a troubling mark, a doctor-led screening are vital.
What about other skin conditions?
Other skin conditions that might bring a child to the dermatologist include chronic or severe eczema, severe acne, fungal infections on the skin or birthmarks present at birth, Lie says.
Bunick adds that viral infections of the skin often send kids to the dermatologist. This includes warts caused by the human papillomavirus (HPV), and molluscum contagiosum, caused by poxvirus. He also recommends that rashes that don’t go away within two weeks be evaluated by a pediatrician or dermatologist. “It is important to establish a diagnosis early so that proper treatment can be initiated. Any rash rapidly changing or associated with severe symptoms should be seen promptly,” he says.
In Zarbo’s practice, she also sees children with persistent diaper rashes, psoriasis, skin discoloration conditions such as vitiligo and pigmentary mosaicism, hair disorders and nail disorders. She also treats children with serious skin diseases such as lupus, genetic blistering disorders and photosensitivity disorders.
So, is there one right age?
Not really. As this 2017 report notes, there is no consensus in the U.S. on regular skin screenings, though getting annual skin checks from the age of 35 (if you have at least one risk factor, such as freckled skin, blond or red hair or a family history of skin cancer) is recommended. Last year a study found there was not sufficient evidence to recommend regular screenings for adolescents and adults without signs of skin cancer. More recently, the American Academy on Dermatology issued this statement urging self-exams.
If a child does have a skin issue, as outlined above, it should be looked into. Otherwise, most dermatology clinics advise waiting at least until adolescence to seek out their services.