Incidence of melanoma has steadily increased in the United States

Over the past several decades, the incidence of melanoma – the most serious form of skin cancer – has steadily increased in the United States.

From 1995 to 2004, melanoma has increased by more than 1 percent per year in this country – in sharp contrast to overall cancer rates that have steadily decreased by 0.6 percent per year during this time. While dermatologists and other public health officials work together to try to reverse this alarming trend, key findings from a successful multi-faceted intervention program designed to increase sun-safe behavior in children could play an important role in decreasing melanoma in future generations.

Speaking at the American Academy of Dermatology's Summer Academy Meeting 2007, dermatologist Martin A. Weinstock, MD, PhD, FAAD, professor of dermatology and community health at Brown University in Providence, R.I., and chief dermatologist at Veterans Affairs Medical Center in Providence, presented a summary of recently published research on the rising incidence of melanoma and trends in sun exposure.

“While the increase in melanoma rates from 1995 to 2004 was not specific to one age group, we did notice an increase in the youngest age group (from ages 15 to 30) and in the age 60 and older age group,” said Dr. Weinstock. “The possible reasons for this increase in younger and older Americans are not documented, but one possible explanation could be more exposure to UV radiation – which we know is the most preventable risk factor for melanoma.”

One population-based study published in the September 2006 issue of the journal Pediatrics found that although there was not a significant change in the proportion of youths that reported getting sunburned from 1998 to 2004, there were some interesting distinctions between the younger and older youths. For example, the 16 - 18 age group had more sunburns during that time period compared to the 11 - 13 and 14 - 15 age groups – including an increase in the reported number of sunburns over the six-year study period. In 2004, 70 percent of the 16- to 18-year-olds reported getting sunburned, an increase from 64 percent reported by this age group in 1998.

In contrast, the study found that the younger age groups (ages 11 - 15) reported fewer sunburns and a decrease in the number of sunburns from 1998 to 2004. Specifically, the youngest age group studied (ages 11 - 13) fared the best in terms of the fewest sunburns – dropping from 75 percent in 1998 to 67 percent in 2004. Those in the 14 - 15 age group also reported a decrease in the number of sunburns from 1998 to 2004 – from 79 percent in 1998 to 70 percent in 2004.

“The study did not provide a definitive explanation as to why the younger age groups had fewer sunburns than their older counterparts, but one possible reason is that younger adolescents are more responsive to parental guidance than older teens – who tend to be influenced more by their peers,” explained Dr. Weinstock. “This trend, however, is worth noting in future public education campaigns geared toward teens and adolescents.”

Another study published in the January 2007 issue of the journal Pediatrics found that a multi-component community-based intervention successfully increased sun-protection behaviors in adolescents entering 6th to 8th “SunSafe in the Middle Years” program, designed as a randomized, controlled trial. The intervention used a broad range of role models – including school personnel, coaches, pediatricians, teen peer advocates and lifeguards – who actively encouraged adolescents to practice proper sun protection in different environments.

“The study found that there was significant improvement in the areas of the body protected by sunscreen, clothing or shade in the adolescents in the 10 communities randomly selected for the intervention versus those in the control towns,” said Dr. Weinstock. “From previous research, we know that compliance with sun-protective behaviors goes down between 6th to 8th grades. I think this study demonstrates that a multi-component program which involves a variety of people influential to this age group can have a positive impact on sun protection behavior and should be considered a model for future educational efforts aimed at adolescents.”

Adults also failed to heed the warnings of dermatologists when it comes to practicing proper sun protection. A new article published in the June 1, 2007, issue of the Centers for Disease Control and Prevention's (CDC's) Morbidity and Mortality Weekly Report presented data showing an upward trend in the incidence of sunburns in U.S. adults. From 1999 to 2004, there was a 2 percent increase in the number of adults 18 years and older who reported getting sunburned (32 percent to 34 percent, respectively). While this represents only a slight increase, Dr. Weinstock pointed out that the data demonstrates that the occurrence of sunburns in the adult population is not decreasing.

“Dermatologists are concerned that melanoma and other skin cancers will continue to increase as long as sun exposure does,” said Dr. Weinstock. “Since we know that overexposure to UV radiation is the most preventable risk factor for developing skin cancer, it's critical for dermatologists to emphasize that people should practice proper protection when engaging in outdoor activities.”

The Academy recommends that people of all ages Be Sun Smart™ by following these tips:

• Generously apply sunscreen with a Sun Protection Factor (SPF) of at least 15 that provides broad-spectrum protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Re-apply every two hours, even on cloudy days, and after swimming or sweating. Look for the AAD Seal of Recognition™ on products that meet these criteria.
• Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
• Seek shade when appropriate, remembering that the sun's rays are strongest between 10 a.m. and 4 p.m.
• Use extra caution near water, snow and sand as they reflect the damaging rays of the sun which can increase your chance of sunburn.
• Protect children from sun exposure by applying sunscreen.
• Get vitamin D safely through a healthy diet that includes vitamin supplements. Don't seek the sun.
• Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.
• Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.

According to current estimates, there will be about 108,230 new cases of melanoma diagnosed in 2007 – 48,290 noninvasive and 59,940 invasive. For more information about skin cancer, visit www.skincarephysicians.com and click on “SkinCancerNet.”

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 15,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails.