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.
- Beddingfield FC 3rd.The melanoma epidemic: res ipsa loquitur. Oncologist. 2003; 8(5):448-50.
- 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