Late Stage Skin Cancers on the Rise in the UK: World Congress on Cancers of the Skin
09/17/2014
Advanced-stage skin cancers are on the rise in the UK, according to two studies presented this month at the World Congress on Cancers of the Skin in Edinburgh, Scotland. The findings highlight an urgent need to publicise self-check and early detection messages, the The Skin Cancer Foundation says.
Skin cancer is the UK's most common cancer. Melanoma is the most dangerous form of the disease, and is relatively unique in that it is a highly visible cancer, allowing people to monitor their skin for changes themselves. As with most cancers, early detection improves the chances of survival.Melanoma tumours grow in ‘thickness' (depth of invasion into the skin) the longer they are left untreated. The ‘Breslow thickness' of a melanoma lesion, measured in millimetres, is used to assess how advanced it is and has five stages, ranging from the cancer cells only being in the outermost layer of the skin, to the tumour being more than 4mm thick.
The first study looked at 1,769 melanoma patients seen at the St. John's Institute of Dermatology at Guy's and St. Thomas' Hospitals in London between 1999 and 2012. They found that the incidence of melanoma increased by 76 per cent during the 13-year period. The Breslow thickness of the melanomas increased across all demographic groups, from a mean of 2.25mm to 2.43 mm.
As the data for thin, early stage tumours was excluded from this study, the results suggest that the overall increase in melanomas being diagnosed is, at least in part, due to more advanced cancers which have a much poorer survival, rather than a surge of early-stage tumours in response to greater awareness of the disease.
Study author Dr Wisam Alwan said: “Our data shows an increase in the number of cases of melanoma seen across all stages of disease, including more advanced tumours, with no improvement in survival seen during the study period.
“The number of people dying from melanoma is increasing year on year and this emphasises the necessity of early detection of tumours, given the poor outcomes associated with advanced disease. Strategies that tackle both the prevention of the disease, and that encourage people to seek help earlier, are crucial.”
The second study, from Barts Health NHS Trust in London, reviewed 92 cases of melanoma seen in the region over one year. 16 per cent (15 cases) of ‘thick malignant melanoma', in which the tumour was greater than 3.5mm and therefore more advanced and harder to treat, were identified. The mean Breslow thickness in this group was 6.4mm, the thickest of the five stages on the Breslow scale (more than 4mm).
Despite the tumour size, 40 per cent of these patients had noticed a changing lesion for at least four months before seeking advice. Interestingly, most (73%) were a type of melanoma called ‘nodular melanoma' and the authors speculate that current early detection messaging, using the ABCD acronym** (which stands for Asymmetry, Border, Colour and Diameter – the key areas of change to look out for), may not be as applicable to this type of the disease as to other subtypes.
Dr Andrew Lock, one of the study's authors, said: “It has been suggested that nodular melanomas behave biologically differently from other subtypes, and the ABCD criteria to aid diagnosis may indeed lead to late presentation. Perhaps the latter is applicable mainly to the superficial spreading subtype, which is the more common type of melanoma.
“Our study reinforces the observation that the incidence of thick melanomas is not decreasing. New strategies and education programmes are therefore required for the earlier detection of such tumours.”
Nina Goad of the British Association of Dermatologists said: “The majority of public education campaigns around skin cancer have focussed on preventing the disease, by staying safe in the sun. What these studies show is that we now also need to target our efforts on early detection, by encouraging people to check their skin and report anything suspicious to their GP sooner rather than later.
“We've been doing this for some years with our Be Sun Aware Roadshow, where we take mole-checking to high profile venues, and we are now trying to target the people we know tend to present late with skin cancer, which tends to be older men.
“However, the studies raise an interesting point about the different melanoma subtypes. Nodular melanomas, which accounted for the majority of melanomas in the review by Barts Health NHS Trust, are less common than the ‘superficial spreading' type of melanoma, to which the ABCD rules apply. Their rate of growth is usually faster and unfortunately they are also harder to diagnose clinically. They become life threatening quickly and can mimic other, less harmful skin cancers and benign skin lesions. This makes public messaging for these cancers tricky, and something we are going to need to think about if we want to reduce our melanoma mortality.”
Skin cancer is the UK's most common cancer. Melanoma is the most dangerous form of the disease, and is relatively unique in that it is a highly visible cancer, allowing people to monitor their skin for changes themselves. As with most cancers, early detection improves the chances of survival.Melanoma tumours grow in ‘thickness' (depth of invasion into the skin) the longer they are left untreated. The ‘Breslow thickness' of a melanoma lesion, measured in millimetres, is used to assess how advanced it is and has five stages, ranging from the cancer cells only being in the outermost layer of the skin, to the tumour being more than 4mm thick.
The first study looked at 1,769 melanoma patients seen at the St. John's Institute of Dermatology at Guy's and St. Thomas' Hospitals in London between 1999 and 2012. They found that the incidence of melanoma increased by 76 per cent during the 13-year period. The Breslow thickness of the melanomas increased across all demographic groups, from a mean of 2.25mm to 2.43 mm.
As the data for thin, early stage tumours was excluded from this study, the results suggest that the overall increase in melanomas being diagnosed is, at least in part, due to more advanced cancers which have a much poorer survival, rather than a surge of early-stage tumours in response to greater awareness of the disease.
Study author Dr Wisam Alwan said: “Our data shows an increase in the number of cases of melanoma seen across all stages of disease, including more advanced tumours, with no improvement in survival seen during the study period.
“The number of people dying from melanoma is increasing year on year and this emphasises the necessity of early detection of tumours, given the poor outcomes associated with advanced disease. Strategies that tackle both the prevention of the disease, and that encourage people to seek help earlier, are crucial.”
The second study, from Barts Health NHS Trust in London, reviewed 92 cases of melanoma seen in the region over one year. 16 per cent (15 cases) of ‘thick malignant melanoma', in which the tumour was greater than 3.5mm and therefore more advanced and harder to treat, were identified. The mean Breslow thickness in this group was 6.4mm, the thickest of the five stages on the Breslow scale (more than 4mm).
Despite the tumour size, 40 per cent of these patients had noticed a changing lesion for at least four months before seeking advice. Interestingly, most (73%) were a type of melanoma called ‘nodular melanoma' and the authors speculate that current early detection messaging, using the ABCD acronym** (which stands for Asymmetry, Border, Colour and Diameter – the key areas of change to look out for), may not be as applicable to this type of the disease as to other subtypes.
Dr Andrew Lock, one of the study's authors, said: “It has been suggested that nodular melanomas behave biologically differently from other subtypes, and the ABCD criteria to aid diagnosis may indeed lead to late presentation. Perhaps the latter is applicable mainly to the superficial spreading subtype, which is the more common type of melanoma.
“Our study reinforces the observation that the incidence of thick melanomas is not decreasing. New strategies and education programmes are therefore required for the earlier detection of such tumours.”
Nina Goad of the British Association of Dermatologists said: “The majority of public education campaigns around skin cancer have focussed on preventing the disease, by staying safe in the sun. What these studies show is that we now also need to target our efforts on early detection, by encouraging people to check their skin and report anything suspicious to their GP sooner rather than later.
“We've been doing this for some years with our Be Sun Aware Roadshow, where we take mole-checking to high profile venues, and we are now trying to target the people we know tend to present late with skin cancer, which tends to be older men.
“However, the studies raise an interesting point about the different melanoma subtypes. Nodular melanomas, which accounted for the majority of melanomas in the review by Barts Health NHS Trust, are less common than the ‘superficial spreading' type of melanoma, to which the ABCD rules apply. Their rate of growth is usually faster and unfortunately they are also harder to diagnose clinically. They become life threatening quickly and can mimic other, less harmful skin cancers and benign skin lesions. This makes public messaging for these cancers tricky, and something we are going to need to think about if we want to reduce our melanoma mortality.”