PracticalDermatology

Melanoma and non-melanoma skin cancers (NMSC) are a significant health concern in the US. About one million Americans have NMSC, and nearly 70,000 have melanoma, according to statistics from NIH and Surveillance Epidemiology and End Results (SEER). Melanoma rates have been increasing in the US and around the world over the past several decades, bringing attention to a melanoma “epidemic.”

One positive finding regarding melanoma incidence is an apparent leveling out of the annual increase in cancer incidence and the trend toward improved survival. The “decrease in the increase” of skin cancer prevalence suggests that education efforts to this point may be affecting patient behaviors and translating to healthier behaviors that will diminish skin cancer risks long-term.

Unfortunately, this positive is balanced by a negative: melanoma rates appear to be on the increase among young Americans, and the increase may be directly related to a tendency toward unhealthy UV habits, particularly tanning.

A recent study investigated the incidence of first liftetime diagnosis of melanoma among young adults (aged 18 to 39). The data were drawn from the Rochester Epidemiology Project data for the time period from January 1, 1970, through December 31, 2009, in Olmsted County, MN. Overall, the incidence of melanoma in young adults increased six-fold over the 40-year period. The increase was highest among women—eight-fold—compared to men—four-fold. Median age and female-male sex distribution at time of diagnosis did not change over time.

Overall and disease-specific survival seemed to improve over time; hazard ratios comparing year of diagnosis with mortality were 0.92 and 0.91, respectively.

An interesting aspect of this analysis is that the researchers reviewed available pathology for melanomas diagnosed in the studied period. Histology was available for 220 of the 256 melanomas, and the melanoma diagnosis was confirmed for all tumors. Twelve melanomas of originally undetermined subtype were assigned a subtype, and two tumors were changed from superficial spreading to spitzoid type. This confirmation of the diagnosis refutes any charge of diagnostic drift over time. That is, there is no indication that truly benign lesions were misdiagnosed as melanoma by overzealous practitioners.

The study authors suggest the failure to heed warnings about the dangers of UV exposure and practice appropriate UV avoidance strategies may account for the increase in melanomas in young adults. Specifically, based on data from other studies showing relatively high rates of UV lamp tanning in young women, the authors suggest that the higher increase in melanoma incidence in young women compared to men may be attributable to tanning bed use.

Read comments from one of the study authors in the May edition of Cutaneous Oncology Today (CutaneousOncologyToday.com), mailed with this edition

Dr. Wolfe has no relevant disclosures.

Jonathan Wolfe, MD is in private practice in Plymouth Meeting, PA and is Clinical Assistant Professor of Dermatology, University of Pennsylvania, Philadelphia.

1. Beddingfield FC 3rd.The melanoma epidemic: res ipsa loquitur. Oncologist. 2003; 8(5):448-50.
2. Reed KB, Brewer JD, Lohse CM, Bringe KE, Pruitt CN, Gibson LE. Increasing incidence of melanoma among young adults: an epidemiological study in Olmsted County, Minnesota. Mayo Clin Proc. 2012 Apr;87(4):328-34