Melanoma’s Mixed Report

Every day there seems to be a new study out regarding the staggering incidences of skin cancer and its fatal cousin, melanoma. The media reports on an increase in tanning bed use then counters with a story on teenagers heeding warnings to stay out of the sun. Adding to this swirl of news is a recent study on melanoma, published in the October 9th issue of the Journal of the American Medical Association (JAMA). Study Design Researchers in Boston analyzed Surveillance, Epidemiology and End Results (SEER) data provided by the National Center for Health Statistics (NCHS). The SEER data looked at mortality rates of Caucasians between 1969 and 1999. The study focused on Caucasians, a group with a 10% to 15% greater risk for skin cancer than Hispanics and African-Americans. Data among women and men were broken into three age groups (20 to 44, 45 to 64, and 65 and older), and trends for the age groups were analyzed. Researchers reviewed the SEER literature to better understand the most recent trends in melanoma mortality as defined by age and sex due to the increase in deaths within the United States between 1973 and 1998. Researchers were surprised to learn that fewer people under 45 years of age are dying from melanoma. In a published report regarding the study, lead author, Alan Geller, M.D., an associate professor in dermatology at Boston University School of Medicine, expressed “incredible surprise.” In his 20 years of melanoma research, Dr. Geller had always believed “the increase in incidence and mortality cut across all age groups.” The Results Are In Though melanoma incidence has increased in the past 30 years, researchers found that mortality rates have persistently decreased among American males and females aged 20 through 44 years. Rates among this age group haven’t increased as they have for older Americans. On the other hand, mortality rates among middle-aged and older men increased over the 30-year span. These two groups remain the highest at-risk group of all the data analyzed. Some highlights from the study include: • In women aged 20 to 44, melanoma mortality decreased by 39% between 1969 and 1999. • In men aged 20 through 44, mortality rates decreased 29% between 1969 and 1999. • In women aged 45 to 64, mortality rates rose 19%. • In men of the same age, mortality rates rose 66%. • In men aged 65 and older, mortality rates increased 157%, a more than 3-fold greater increase than for women of the same age. • The overall mortality rate rose from 2 to 3 per 100,000 from 1969 to 1999, mainly due to the rise in melanoma deaths among men 65 and older. According to the research, incidence data generally paralleled mortality data. Incidence findings include: • Men aged 45 to 64 revealed a three-fold increase and nearly a five-fold increase in men aged 65 and older. • Incidence data for men aged 20 to 44 less than doubled over the 30-year period (6.8 to 11.6 per 100,000). Incidences increased among women in older age groups, but incidences were lower for women than men. Final Notes The researchers conclude mortality and incidence rates have decreased persistently over the 30-year period, among younger age groups. Their findings regarding incidence and mortality rates of males versus females are consistent with recent studies that reflect a distance-stage tumor decline among women rather than men. Researchers attribute the higher mortality rate of older men to infrequent doctor visits and lack of routine skin checks versus women who are more attentive to changes in their skin. The study emphasizes the need for early detection and for an outreach to a population compromised by decades of excessive sun exposure.