Early detection
of thick melanomas
remains same despite campaigns promoting
early detection, increased awareness
Newswise — Despite campaigns promoting early detection and increased
awareness of melanoma (skin cancer) the proportion of the most
aggressive and deadly form of melanoma remains the same, according
to an article in the June issue of Archives of Dermatology, one of
the JAMA/Archives journals.
Incidence and mortality of melanoma (skin cancer) in the United
States have risen steeply from 1969 to 1999, according to background
information in the article, with a disproportionally greater
increase in men 65 years and older. Melanoma mortality (death) is
strongly associated with the thickness of the primary lesion.
Marie-France Demierre, M.D., FRCPC, of Boston University School of
Medicine, and colleagues analyzed data from the Surveillance,
Epidemiology, and End Results (SEER) database to determine trends in
distribution of thin and thick melanoma from 1988 to 1999. The
researchers found that the number of new melanoma cases in a three
year period increased 60 percent from 1988-1991 (n=9,132) to
1996-1999 (n= 14,575). The proportion of thick melanomas (at least
two millimeters thick) remained relatively stable during the 12
study years. Nodular melanoma (NM, an aggressive type of melanoma)
comprised nine percent of all recorded cases but 34 percent of the
thick melanomas. In contrast, superficial spreading melanoma (a more
common type of melanoma, that grows more horizontally in the skin)
was almost uniformly diagnosed as an early tumor, mostly presenting
as thin melanoma.
“A
substantial number of thick melanomas in the United States are of
the nodular subtype,” the authors conclude. “… apparently the
current ABCD of melanoma, the core of the early-detection
educational programs, may not suffice to permit the early detection
of NM. … For example, it is apparent that targeting middle-aged and
older men is warranted. This observation has been supported by the
Institute of Medicine, which conceded that ‘clinicians and patients
should continue to be alert to the common signs of skin cancer—with
a particular emphasis on older white males and on melanoma.’
Finally, as we gain greater understanding of melanoma carcinogenesis
and molecular alterations leading to the development of biologically
aggressive thick melanomas, other strategies such as chemoprevention
may play a role in reducing the risk of developing thick melanoma
and decreasing mortality from melanoma.”
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