Melanoma epidemic: Facts and controversies
Section snippets
Incidence and mortality trends of cutaneous malignant melanoma
Many epidemiologic studies have evaluated the incidence and mortality statistics of MM in the United States (U.S.) and worldwide. Since 1973, the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute has been collecting and publishing data from population-based cancer registries and currently covers 26% of the U.S. population. MM is one of only 14 cancer types that has been increasing in incidence during the past few decades.
In general, cancer incidence is
Is this real?
Those who believe that this worldwide melanoma incidence increase represents a true epidemic take the statistics at face value, with res ipsa loquitur (“the thing speaks for itself”)7 and “if it quacks like a duck...”5 accurately summing up the primary argument for a true epidemic.2,3, 4, 5, 6, 7 Those who are more skeptical of an epidemic have posed multiple explanations for the incidence data, including (1) length-time bias, (2) increased surveillance intensity, (3) diagnostic uncertainty,
If real, then why?
One would be hard-pressed to find a dermatologist who does not agree that sun exposure contributes in some manner to the development of MM. Increased sun exposure related to increased tanning bed use throughout the 1990s and degradation of the ozone layer have been offered as explanations of why the incidence of melanoma is increasing.12 This may be especially relevant to young women, because there has been a sharp increase in melanoma incidence in the past 10 years in women aged 25 to 29 years
Future directions
Although experts in the field disagree on the epidemic proportion of melanoma, it is inarguable that this is an insidious cancer that is preventable in most cases. Rigel insists that “an ounce of prevention is worth a pound of cure,” and breaks down the criteria for diseases for which standard screening is cost-effective: (1) early detection must positively affect outcomes, (2) the screening process must be straightforward, and (3) the screening must be cost-effective.34 MM and nonmelanoma skin
Conclusions
The question posed of whether a melanoma epidemic truly exists is difficult to answer definitively in the absence of randomized controlled trials to evaluate the true effect of increased surveillance and biopsies on mortality rates. We will also never know what would have become of the 1-mm melanoma once it is fixed in formalin. Until we have new methods for determining the malignant potential of pigmented neoplasms, or a time machine, we must keep in mind the grim yet real possibility that the
References (34)
- et al.
The incidence of malignant melanoma in the United States: issues as we approach the 21st century
J Am Acad Dermatol
(1996) - et al.
The melanoma epidemic: more apparent than real?
Mayo Clin Proc
(1997) - et al.
Recent trends in incidence of cutaneous melanoma among US Caucasian young adults
J Inv Dermatol
(2008) - et al.
Time trends of incidence, mortality, and relative survival of invasive skin melanoma in Lithuania
Eur J Cancer
(2006) - et al.
Exposure to the sun and sunbeds and the risk of cutaneous melanoma in the UK: a case-control study
Eur J Cancer
(2004) - et al.
Prevalence and correlates of indoor tanning among US adults
J Am Acad Dermatol
(2008) - et al.
Prevalence of sunless tanning product use and related behaviors among adults in the United States: results from a national survey
J Am Acad Dermatol
(2007) - et al.
Melanoma epidemic: true or false?
Int J Dermatol
(2004) - et al.
Cutaneous melanoma—past, present, and future
J Am Acad Dermatol
(2004)
Melanoma incidence: if it quacks like a duck
Arch Dermatol
“Epidemic” of malignant melanoma: true increase or better detection?
J Am Med Assoc
The melanoma epidemic: res ipsa loquitur
Oncologist
The melanoma epidemic: is increased surveillance the solution or the problem?
Arch Dermatol
Melanoma incidence: if it quacks like a duck…
Arch Dermatol
Annual report to the Nation on the status of cancer (1973-1998), Featuring cancers with recent increasing trends
J Natl Cancer Inst
Recent trends in cutaneous melanoma incidence among whites in the United States
J Natl Cancer Inst
Cited by (52)
Skin cancer: Primary, secondary, and tertiary prevention. Part II.
2022, Journal of the American Academy of DermatologyEvidence concerning the accusation that melanoma is overdiagnosed
2021, Journal of the American Academy of DermatologyCurrent controversies in early-stage melanoma: Questions on incidence, screening, and histologic regression
2019, Journal of the American Academy of DermatologyPerineural Spread of Melanoma to the Brachial Plexus: Identifying the Anatomic Pathway(s)
2018, World NeurosurgeryContinued Increase in Melanoma Incidence across all Socioeconomic Status Groups in California, 1998–2012
2017, Journal of Investigative DermatologyCitation Excerpt :Dramatic increases in the incidence of cutaneous melanoma have occurred among populations in the United States and other parts of the world in the last half of the 20th century, with rates increasing 3- to 5-fold over the span of only two to three decades (Dennis, 1999; Garbe and Leiter, 2009; Giblin and Thomas, 2007; Hall et al., 1999; Jemal et al., 2001; Levell et al.; 2009). Although these increases have raised public health concerns (US Department of Health and Human Services Office of the Surgeon General, 2014), they have also sparked controversy as to whether they represent a true melanoma epidemic or an artifact of expanded screening programs (De Giorgi et al., 2012; Dennis, 1999; Erickson and Driscoll, 2010; Levell et al., 2009; Swerlick and Chen, 1996; Swerlick and Chen, 1997). To inform answers to this question, we previously published a study of invasive cutaneous melanoma occurrence during the period of 1988 through 2002 among non-Hispanic whites in California, in which we conducted the first examination of incidence trends across small-area (census tract) neighborhoods categorized by socioeconomic status (SES) (Linos et al., 2009).
Trends in the diagnosis and clinical features of melanoma in situ (MIS) in US men and women: A prospective, observational study
2016, Journal of the American Academy of Dermatology