Jaime Regen Rea spent her childhood summers basking by the neighborhood swimming pool, steadily burning to a crisp.
The Allen resident was the self-described "stupid kid" in high school who visited tanning salons nearly every day. She wanted to be cool, and cool meant tan.
Then in 1997, during a routine exam, a doctor noticed a suspicious mole about the size of a nickel on her shoulder blade. It turned out to be melanoma. She was 20.
Eight years later, her cancer has not left her.
Doctors nationwide have been troubled by what they see as a growing incidence of melanoma among younger patients. Pediatric melanoma, for example, once almost unheard of, now affects about 7 children per million, according to 2002 statistics from the National Cancer Institute. While that amounts to only about 500 children each year, the number has risen from 3 per million in 1982.
Dr. Charles Balch of the American Society of Clinical Oncology, who has specialized in melanoma for 30 years, saw his first pediatric case five years ago. Since then, Johns Hopkins Hospital, where he works, has treated about 20 youngsters, the youngest just 8 years old.
Recent studies also report increases in England, Sweden and Australia.
Dr. Anthony Mancini, dermatology chief at Children's Memorial Hospital in Chicago, has treated eight cases in the last nine years, about double the number seen in the previous two decades.
"There's an appropriate level of alarm here," Dr. Mancini said. "Clearly it's happening, and it's deadly, and it's missed."
Melanoma prevalence has risen in adults, too – more than doubling in the last 30 years, according to the cancer institute. The American Cancer Society estimates that this year about 60,000 U.S. adults will develop melanoma and that 7,700 will die from it.
At age 10, freckle-faced Corey Halpin of Hanover Park, Ill., a Chicago suburb, had bigger things to think about, like basketball and Boy Scouts, than the little black mole he noticed on his arm while camping.
At first, he thought it might be a tick. "I pushed it, but it didn't move," he recalled. "But it bled."
It wasn't until a few months later, during a spring 2002 visit to his pediatrician, that Corey casually asked his dad if he should mention the odd mole. That led to a referral to a specialist and alarming test results that caught even his doctors by surprise.
"My husband and I were scared to death," and so was Corey, said his mother, Marge Halpin. Corey has no relatives with melanoma or any other kind of cancer. But he does have other risk factors – fair skin, red hair and green eyes.
Some pediatricians who see unusual moles in children "would ordinarily dismiss this as nothing because melanoma is not supposed to happen in this age group," Dr. Balch said. "We all should be aware that this can occur and biopsy suspicious or changing moles in children."
Dr. Balch said reasons for the increase are uncertain. Some doctors think it might be from depletion of the ozone layer, which protects the Earth from some of the sun's damaging ultraviolet radiation. Others attribute it to excessive sun exposure and blistering sunburns in early childhood, though some experts had thought it took much longer for skin damage from repeated sun exposure to develop into cancer.
Melanoma develops in skin cells called melanocytes, which produce the pigment that colors the skin's surface and protects deeper layers from sun damage. It is much more invasive and likely to spread to other parts of the body than other skin cancers.
Research from Italian doctors published in the March edition of the journal Pediatrics found that melanoma lesions in children sometimes look different from those in adults and may be misdiagnosed.
In adults, melanoma often looks like a black or very dark brown mole, or one with irregular borders. But half the Italian children studied had lighter-colored lesions, and most had well-defined borders.
Also unlike adults, most children with melanoma have no family history of the disease, and they may lack other risk factors including moles present since birth, Dr. Balch said.
Particularly troubling to doctors who treat skin cancer is the growing melanoma incidence in people like Ms. Regen Rea – those younger than 30. While doctors for years agonized mainly about the sun's damaging rays, they now have a new worry in tanning beds.
Some studies suggest that teenagers and 20-somethings believe that they are avoiding skin damage by getting an indoor brown, doctors said, but that is not so. The cellular damage from sunlight occurs because of its ultraviolet rays. Tanning bed lamps also emit UV rays.
"Ten trips to the tanning bed doubles your risk of melanoma," said Dr. Darren Casey, an Atlanta dermatologic surgeon.
Amy Busby of Magnolia, near Houston, found a dime-sized mole on the back of her thigh during law school in December 2002.
"Man, this doesn't look good," she said at the time.
Her melanoma was diagnosed in January 2003, when she was 30.
Ms. Busby avoided the sun as a child and slapped on sunscreen whenever she was exposed to sunlight. She had a couple of severe burns as a youngster, but she said she inspected her skin and didn't have a family history of skin cancer.
Ms. Busby, now 32, said she doesn't think she'll be able to live a normal life.
She has dropped out of law school and stays at home to raise her 4-year-old son and 9-year-old daughter.
"I feel like I'm living my life with this artificial deadline," she said. "I probably won't live as long as I want to live. I may not see my son go to kindergarten a year from now. I may not see my daughter graduate from high school seven years from now."
"But I do what I can to stay positive," she added. "And I do what I can to stay around."
Ms. Regen Rea, too, worries about her future. In 2002, doctors removed a grapefruit-sized tumor in her abdomen. An ovary was removed in 2003. Last December, doctors removed a mass near her heart.
She said the mass has reappeared. Despite the melanoma, Ms. Regen Rea remains upbeat. She leans on her husband, Brent, and family for support. She estimated that she and her family have spent tens of thousands of dollars for drugs and treatments.
She wishes she hadn't visited tanning beds so young.
"I regret going because I know it had something to do with it," she said. "But I can't blame one particular thing."
Battle scars from surgeries remind her of the melanoma. A 12-inch scar runs down her back. Another scar appears on the front of her body.
"I don't wear bikinis," she said, laughing.
Today, she shudders when she spots high schoolers walking into tanning salons.
"I see kids going in these days, and I'm just like, 'Wow, they just don't even know,' " she says.
The sun is not good for anyone who spends a great deal of time outdoors, but some people are more vulnerable to its damaging rays than others. Highest-risk people include those:
• With fair skin and freckles
• With red hair and green eyes, or blonde hair and blue eyes
• With family or personal history of melanoma
• With moles
• Who were severely sunburned early in life
• Who have used a tanning bed 10 times or more
While most skin cancers are highly curable, melanoma can be deadly. Here are some things to know about this cancer that kills nearly 8,000 a year and is on the rise.
• In 90 percent of cases, severe sunburns trigger melanoma.
• In the United States in 2003, one in 65 people had a lifetime risk of getting the disease; it is projected that by 2010, one in 50 Americans will be afflicted by melanoma.
• It is the second most common cancer in women between the ages of 20 and 35 and the leading cause of cancer death in women ages 25 to 30.
• The incidence rate for melanoma has more than doubled since 1973.