Melanoma Rates Continue to Rise


This from D. Garth Sullivan, Esq. at Indox Consulting. Mr. Sullivan writes to attorneys every week with news from legal-medical frontiers:

The incidence of melanoma has steadily increased in the United States, and from 1995 to 2004, the rate of melanoma rose by more than 1% per year. The rising increase in melanoma is not specific to 1 age group, but the incidence was particularly noted among young adults and the elderly, explained Martin A. Weinstock, MD, PhD, professor of dermatology and community health at Brown University, in Providence, Rhode Island, and chief dermatologist at Veterans Affairs Medical Center in Providence. He was speaking last week at a plenary session at the American Academy of Dermatology's Summer Academy Meeting 2007.

"Of the 10 leading types of cancer, other than keratinocyte carcinomas, only kidney cancer and melanoma rates are increasing," Dr. Weinstock told Medscape in an interview.

There are several possible reasons for the increased incidence in younger and older individuals, said Dr. Weinstock. "Possible changes in diagnostic criteria, increased surveillance, and increased UV exposure may all account for it."

Data from a population based study published in 2006 found that despite public education campaigns to reduce sun exposure, there was little improvement in sun-protection practices and reducing sunburns among youths between 1998 and 2004. (Cokkinides V et al. Pediatrics 2006;118:853-864). According to the survey, which examined trends on sunburns, sun protection, and attitudes related to sun exposure among individuals aged 11 to 18 years, 69% of participants reported having been sunburned during the summer in 2004. This rate was only slightly less than the 72% reported in 1998.

However, when the data were broken down by age, there was a significant decrease in the percentage of youngsters aged 11 to 15 years who reported sunburns, while there was a nonsignificant increase among the 16- to 18-year-olds. The proportion of participants who reported using sunscreen on a regular basis in 2004 was also significantly higher than in 1998 (39% vs 31%).

"A [Centers for Disease Control and Prevention] CDC survey also reported that adults were getting more sunburns in 2004, as compared with 1999," said Dr. Weinstock.

The results of this survey (CDC. MMWR Morb Mortal Wkly Rep. 2007;56:524-528) indicated that sunburn prevalence among all participants rose from 31.8% in 1999 to 33.7% in 2004. Men were reported to have a higher prevalence of sunburn than women during 3 survey years: 35.8% vs 28% in 1999, 37% vs 30.2% in 2003, and 37% vs 30.3% in 2004. The incidence of sunburn was also reported among ethnic and racial groups usually considered to be at low risk of getting sunburn, such as American Indians/Alaska Natives (30.4% for men, 21.5% for women), black Hispanics (12.4% for men, 9.5% for women in 2004), and Asians/Pacific Islanders (16% for men and women). 
While the study found only a small 2% increase in the percentage of adults who reported getting sunburned during that time period, it also showed that the occurrence of sunburns was not declining.

Dr. Weinstock also reviewed the effectiveness of different interventions in changing sun-exposure behaviors. One study conducted in Australia evaluated the efficacy of delivering solar UV forecasts and supporting communications in promoting personal sun-protection practices on weekends (Dixon HG et al. Health Educ Behav. 2007;34: 486-502). The researchers involved in the study did not find any significant changes in behaviors such as the use of hats and sunscreen or sun avoidance that was related to solar-UV forecasts.

On the other hand, another study found that found that a multicomponent community-based intervention was able to successfully increase sun-protection behaviors in children entering sixth to eighth grades. The program involved a variety of role models that included school personnel, coaches, pediatricians, teen peer advocates and lifeguards, all of whom actively encouraged the youths to practice appropriate sun-protection practices (Olson AL et al. Pediatrics. 2007;119:e247-256).

Dr. Weinstock also pointed out that there are benefits from UV exposure, in that it is needed to fuel vitamin D production. "Most physical activity also takes place outdoors," he said. "Therefore, it is important that dermatologists do not tell their patients to avoid the sun completely because of the importance of physical activity and its preventive effect against numerous illnesses, as well as obesity."

When people do engage in outdoor activities, they need to protect themselves from overexposure to UV radiation. "There are 3 public health messages that I focus on," said Dr. Weinstock, "the first being that the healthiest color for your skin is the one you were born with."

The belief that suntans make a person more physically attractive is a primary motive for suntanning behavior. "If you have fair skin and try to make it tan, you are setting yourself up for a problem," he explained. "There is a whole psychology of pursuing a tan, and that is not a good thing. I would focus intervention efforts on changing that perception.

"The second message is that supplements are a safer source of vitamin D than UV radiation, if you need more vitamin D," said Dr. Weinstock. "It is a safer to take vitamin supplements than spend more time in the sun getting excessive UV exposure."

Third, when it comes to protecting the skin, Dr. Weinstock advocates "Slip, slop, slap," which is to slip on a shirt, slop on the sunscreen, and slap on a hat. "This sun-protection message has been adopted by the American Cancer Society as a way of encouraging protection from harmful UV radiation without interfering with physical activity," he said.