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.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
