Approximately three-fourths of all skin cancer-associated deaths
are caused by melanoma. During 1973 to 1991, the incidence of
melanoma increased approximately 4% each year. In addition, the
incidence of melanoma is increasing faster than that of any other
cancer. To characterize the distribution of deaths from melanoma
in the United States, the CDC analyzed national mortality data
for 1973 through 1992. This report by the Division of Cancer Prevention
and Control, National Center for Chronic Disease Prevention and
Health Promotion, CDC, summarizes the results of that analysis.
Decedents for whom the underlying cause of death was melanoma
(International Classification of Diseases, Adapted, Ninth Revision,
codes 172.0-172.9) were identified from public-use mortality data
tapes from 1973 through 1992. The denominators for rate calculations
were derived from US census population estimates. Rates were directly
standardized to the age distribution of the 1970 US population
and were analyzed by state, age group, sex, year, and race. To
increase the precision of the rates presented, race was characterized
as white and all other races because approximately 98% of deaths
from melanoma occurred among whites.
An Increase in the Death Rate
From 1973 through 1992, the overall percentage increase in the
rate of deaths from melanoma (34.1%) was the third highest of
all cancers; for males, the percentage increase for melanoma (47.9%)
was the highest for all cancers. During the same period, the increase
in the rate of deaths from melanoma was greater for white males
than for other racial and sex groups (Figure 1). In 1992, the
rate of deaths from melanoma was 5.9 times higher for whites than
for all other races (2.5 and 0.4 per 100,000 population, respectively)
and 2.1 times higher for males than females (3.1 and 1.5, respectively).
To increase statistical precision, the rate of deaths from melanoma
by state was aggregated for 1988 to 1992. In every state, the
rate of deaths from melanoma was substantially higher for whites
than for persons of all other races. For whites, the age-adjusted
death rate by state ranged from 2.2 to 5.0 per 100,000 population
for males and 0.8 to 2.3 per 100,000 for females. Most states
that are in the two highest death rate quartiles are not in the
lower US latitudes where sun exposure is generally more intense.
During 1973-1975 and 1990-1992, death rates were highest for white
men over the age of 50 (Figure 2). The death rate increased more
with age for males than for females during 1990 to 1992.
Editorial Note from the CDC
The findings in this report indicate that the rate of deaths from
melanoma was higher for whites than persons of all other races--a
finding consistent with the more common occurrence of melanoma
among persons with lightly pigmented skin and an incidence among
whites that is more than 10 times higher than that for blacks.
Based on estimates by the American Cancer Society, during 1995
an estimated 34,100 new cases of melanoma will be diagnosed and
7,200 deaths will be caused by melanoma. The likelihood of survival
of patients with melanoma is substantially greater if the disease
is detected early and treated. Early detection of thin lesions
is associated with improved prognosis and treatment outcome than
is detection of thicker, later-stage tumors.
Risk factors for melanoma related to ultraviolet radiation exposure
include a history of sunburn or sun sensitivity, a tendency to
freckle, the presence of lightly pigmented skin, blue eyes, and
blond or red hair. Other risk factors include a family or personal
history of melanoma and the presence of a large number of moles
or any atypical moles. Sources for exposure to ultraviolet radiation
include sunlight and artificial light (eg, tanning booths), both
of which can cause acute sunburn. The increased risk among persons
who sustain intermittent, acute sunburn at an early age (ie, <
18 years) underscores the need for initiating prevention measures
early in childhood.
Adults, particularly older men in whom rates of deaths from melanoma
are highest, should be encouraged to perform periodic skin self-examination
or be examined by a family member to monitor the location, size,
and color of a pigmented lesion or mole. The ABCD approach can
be used to assess pigmented lesions and represents mole asymmetry
(A), border irregularity (B), nonuniform color (ie, pigmentation;
C), and diameter > 6 mm (D).
Recommendations for preventing melanoma should emphasize reduction
of direct exposure to the sun when sunburn is most likely to occur,
especially from 10 am to 3 pm. Specific measures include wearing
a broad-brimmed hat and clothes that protect sun-exposed areas,
seeking shade when outdoors, using a sunscreen of sun protection
factor > 15 that provides protection against ultraviolet A
and ultraviolet B radiation, and referring to the daily Ultraviolet
Index rating provided by the National Weather Service and other
organizations when planning outdoor activities.
In 1994, the CDC implemented a program to assist in achievement
of the national health objectives for the year 2000 for preventing
skin cancer. Elements of the CDC program include funding support
for state health departments to develop and implement prevention
projects aimed at parents and caregivers of young children; enhancing
prevention messages for the public; initiating the development
of school health curriculum guidelines; enhancing Ultraviolet
Index public health messages; and developing a public and professional
education plan for skin cancer prevention.
From Morbidity and Mortality Weekly Report, vol. 44, no.