Supplement Captures Snapshot of Melanoma Epidemiology

While the recently published supplement on melanoma in the Journal of the American Academy of Dermatology doesn’t offer evidence of many new trends, it does provide an important estimate of the burden of the disease and suggests new targets for education and surveillance.

"The best way to characterize this nice ensemble of studies is that it literally takes a pulse on the epidemic," Dr. Hensin Tsao said of the collection of studies (J. Am. Acad. Dermatol 2011;65[suppl. 1]:S1-143) in an interview. Dr. Tsao is the clinical director of the Melanoma Center and Pigmented Lesion Center at Massachusetts General Hospital in Boston.

Dr. Randall K. Roenigk, a professor of dermatology at the Mayo Clinic in Rochester, Minn., agreed. "It summarizes some facts that are pretty well known but it solidifies some [others]," he said in an interview.

The supplements were published as a joint effort by the American Academy of Dermatology and the Centers for Disease Control and Prevention. The included studies were largely based on data from the Surveillance, Epidemiology, and End Results (SEER) registry that is maintained by the National Cancer Institute.

"The incidence of melanoma is still increasing, and the mortality has not decreased," said Dr. Tsao. "So the biggest take-home message is that this burden is still growing."

Dr. Roenigk noted that "people interpret that one of two ways. They either say that it’s increasing because we’re doing a better job of surveillance or that people are just getting more cancers. However, he added, "some people say that the death rate should also increase if the incidence rate is increasing; but because it’s flat, some people say that maybe our criteria for diagnosis have changed a little bit ... I don’t know if [the supplement] answers that. It’s a little bit of a controversy. But the positive spin on it would be that while the incidence rate is increasing, we’re able to catch it in time that the death rate is staying about the same."

The take home messages from the supplement include: cancer incidence is increasing in younger individuals, particularly younger women; the greatest melanoma mortality is seen among elderly men; and dermatologists have an important chance to improve surveillance of melanoma by reporting their data to registries, such as the SEER database.

Young Women

The study of melanoma in adolescents and young adults aged 15-39 years (J. Am. Acad. Dermatol 2011;65[suppl. 1]:S38-49) found the incidence of melanoma to be rising in that age group. "There have been a number of studies in this younger age group showing the incidence shooting up, especially among women," said Dr. Tsao. "This study substantiates previously published data."

According to Dr. Roenigk, it has been suggested that "the increased incidence in melanoma could just be due to people living longer ... but obviously with people under the age of 40 it’s not so much living longer, it’s probably behavioral or it’s environmental ... but not necessarily longevity."

Dr. Tsao noted that the increasing melanoma incidence in this age group "has implications for what we can do now on some regulatory level ... and for what we expect to happen in 20 years. Are we going to get a whole cohort of advanced-disease women because there is a lag time in the formation of [melanomas] ... It’s a cautionary tale for the future but it’s certainly a point of intervention now."

Tanning beds continue to be a source of controversy at all levels of government nationwide. The AAD, states, local organizations, and others are working to tackle the issue of access to tanning beds.

Education may prove even harder. "We have a lot of room to improve ... despite pretty heavy messaging ... people are either fatigued with the message or they have competing interests," said Dr. Tsao. "There are even more and more studies out there suggesting that even the long-wave ‘safer tans’ like UVA can cause the same types of genetic damage ... I’m not sure that the words ‘safe tan’ makes any sense. A lot of exposure even to long-wave UVA may lead to the chronic skin cancer environment in the skin."

Older Men

The other newer information asks who is dying from melanoma. "Overall, yes, young women are getting melanoma," but if you’re asking who is dying from melanoma, it is old men. You’ll see this theme throughout many of the articles," said Dr. Tsao. "Elderly men are getting to be the most susceptible group – it appears – for melanoma if you look at the death rates." In this age group the rates of melanoma mortality are much greater in men than in women (J. Am. Acad. Dermatol 2011;65[suppl. 1]:S78-86).

"This is going to have clinical impact down the line," Dr. Tsao noted. "Many of these [older] people have melanomas on the head and neck, which appear to have a worse prognosis." These tumors are thick, often nodular in subtype and with a lot of negative features in the pathology report. "We don’t really understand this phenotype – it may be the tumor, it may be the host, it may be the chronically sun-damaged skin surface."

However, "the question is how you get that group to be potentially screened – and how screening within this group is going to impact mortality," he noted. "We’re still optimistic that with proper screening, we can make a difference in mortality."

Dr. Tsao uses the mnemonic MENN (male, elderly, neck/scalp/trunk, nodular type melanoma) to thoroughly check for melanomas in this patient population, regardless of the reason for presentation.

Melanoma Registries

"One of the ways that we can study the burden of a skin disease is by having nationalized records. It doesn’t exist for most other skin diseases," said Dr. Tsao. "Still, most dermatologists in practice don’t think about registering their melanomas, even though this is one of the most codified disorders in all of dermatology ... maybe this is something that we need to work on ... the only way that we can make progress toward documenting the burden of skin disease is that we document the burden of skin disease."

There are likely a large number of melanomas that are diagnosed in the community and the question is whether those are getting recorded in a registry. "In most large hospitals or tertiary care centers, cancers undergo registration. But this may not be the case in private practice," Dr. Tsao said. "If we’re underestimating the burden of melanoma, then in some ways we’re shortchanging ourselves. Given the long-range surveillance, dermatologists are becoming the primary caretakers of melanoma patients in this country in terms of sheer volume ... dermatologists have an opportunity to detect at an early stage and to deflect these patients away from advanced disease."

While the recently published supplement on melanoma in the Journal of the American Academy of Dermatology doesn’t offer evidence of many new trends, it does provide an important estimate of the burden of the disease and suggests new targets for education and surveillance.

"The best way to characterize this nice ensemble of studies is that it literally takes a pulse on the epidemic," Dr. Hensin Tsao said of the collection of studies (J. Am. Acad. Dermatol 2011;65[suppl. 1]:S1-143) in an interview. Dr. Tsao is the clinical director of the Melanoma Center and Pigmented Lesion Center at Massachusetts General Hospital in Boston.

Dr. Randall K. Roenigk, a professor of dermatology at the Mayo Clinic in Rochester, Minn., agreed. "It summarizes some facts that are pretty well known but it solidifies some [others]," he said in an interview.

The supplements were published as a joint effort by the American Academy of Dermatology and the Centers for Disease Control and Prevention. The included studies were largely based on data from the Surveillance, Epidemiology, and End Results (SEER) registry that is maintained by the National Cancer Institute.

"The incidence of melanoma is still increasing, and the mortality has not decreased," said Dr. Tsao. "So the biggest take-home message is that this burden is still growing."

Dr. Roenigk noted that "people interpret that one of two ways. They either say that it’s increasing because we’re doing a better job of surveillance or that people are just getting more cancers. However, he added, "some people say that the death rate should also increase if the incidence rate is increasing; but because it’s flat, some people say that maybe our criteria for diagnosis have changed a little bit ... I don’t know if [the supplement] answers that. It’s a little bit of a controversy. But the positive spin on it would be that while the incidence rate is increasing, we’re able to catch it in time that the death rate is staying about the same."

The take home messages from the supplement include: cancer incidence is increasing in younger individuals, particularly younger women; the greatest melanoma mortality is seen among elderly men; and dermatologists have an important chance to improve surveillance of melanoma by reporting their data to registries, such as the SEER database.

Young Women

The study of melanoma in adolescents and young adults aged 15-39 years (J. Am. Acad. Dermatol 2011;65[suppl. 1]:S38-49) found the incidence of melanoma to be rising in that age group. "There have been a number of studies in this younger age group showing the incidence shooting up, especially among women," said Dr. Tsao. "This study substantiates previously published data."

According to Dr. Roenigk, it has been suggested that "the increased incidence in melanoma could just be due to people living longer ... but obviously with people under the age of 40 it’s not so much living longer, it’s probably behavioral or it’s environmental ... but not necessarily longevity."

Dr. Tsao noted that the increasing melanoma incidence in this age group "has implications for what we can do now on some regulatory level ... and for what we expect to happen in 20 years. Are we going to get a whole cohort of advanced-disease women because there is a lag time in the formation of [melanomas] ... It’s a cautionary tale for the future but it’s certainly a point of intervention now."

Tanning beds continue to be a source of controversy at all levels of government nationwide. The AAD, states, local organizations, and others are working to tackle the issue of access to tanning beds.

Education may prove even harder. "We have a lot of room to improve ... despite pretty heavy messaging ... people are either fatigued with the message or they have competing interests," said Dr. Tsao. "There are even more and more studies out there suggesting that even the long-wave ‘safer tans’ like UVA can cause the same types of genetic damage ... I’m not sure that the words ‘safe tan’ makes any sense. A lot of exposure even to long-wave UVA may lead to the chronic skin cancer environment in the skin."

Older Men

The other newer information asks who is dying from melanoma. "Overall, yes, young women are getting melanoma," but if you’re asking who is dying from melanoma, it is old men. You’ll see this theme throughout many of the articles," said Dr. Tsao. "Elderly men are getting to be the most susceptible group – it appears – for melanoma if you look at the death rates." In this age group the rates of melanoma mortality are much greater in men than in women (J. Am. Acad. Dermatol 2011;65[suppl. 1]:S78-86).

"This is going to have clinical impact down the line," Dr. Tsao noted. "Many of these [older] people have melanomas on the head and neck, which appear to have a worse prognosis." These tumors are thick, often nodular in subtype and with a lot of negative features in the pathology report. "We don’t really understand this phenotype – it may be the tumor, it may be the host, it may be the chronically sun-damaged skin surface."

However, "the question is how you get that group to be potentially screened – and how screening within this group is going to impact mortality," he noted. "We’re still optimistic that with proper screening, we can make a difference in mortality."

Dr. Tsao uses the mnemonic MENN (male, elderly, neck/scalp/trunk, nodular type melanoma) to thoroughly check for melanomas in this patient population, regardless of the reason for presentation.

Melanoma Registries

"One of the ways that we can study the burden of a skin disease is by having nationalized records. It doesn’t exist for most other skin diseases," said Dr. Tsao. "Still, most dermatologists in practice don’t think about registering their melanomas, even though this is one of the most codified disorders in all of dermatology ... maybe this is something that we need to work on ... the only way that we can make progress toward documenting the burden of skin disease is that we document the burden of skin disease."

There are likely a large number of melanomas that are diagnosed in the community and the question is whether those are getting recorded in a registry. "In most large hospitals or tertiary care centers, cancers undergo registration. But this may not be the case in private practice," Dr. Tsao said. "If we’re underestimating the burden of melanoma, then in some ways we’re shortchanging ourselves. Given the long-range surveillance, dermatologists are becoming the primary caretakers of melanoma patients in this country in terms of sheer volume ... dermatologists have an opportunity to detect at an early stage and to deflect these patients away from advanced disease."

While the recently published supplement on melanoma in the Journal of the American Academy of Dermatology doesn’t offer evidence of many new trends, it does provide an important estimate of the burden of the disease and suggests new targets for education and surveillance.

"The best way to characterize this nice ensemble of studies is that it literally takes a pulse on the epidemic," Dr. Hensin Tsao said of the collection of studies (J. Am. Acad. Dermatol 2011;65[suppl. 1]:S1-143) in an interview. Dr. Tsao is the clinical director of the Melanoma Center and Pigmented Lesion Center at Massachusetts General Hospital in Boston.

Dr. Randall K. Roenigk, a professor of dermatology at the Mayo Clinic in Rochester, Minn., agreed. "It summarizes some facts that are pretty well known but it solidifies some [others]," he said in an interview.

The supplements were published as a joint effort by the American Academy of Dermatology and the Centers for Disease Control and Prevention. The included studies were largely based on data from the Surveillance, Epidemiology, and End Results (SEER) registry that is maintained by the National Cancer Institute.

"The incidence of melanoma is still increasing, and the mortality has not decreased," said Dr. Tsao. "So the biggest take-home message is that this burden is still growing."

Dr. Roenigk noted that "people interpret that one of two ways. They either say that it’s increasing because we’re doing a better job of surveillance or that people are just getting more cancers. However, he added, "some people say that the death rate should also increase if the incidence rate is increasing; but because it’s flat, some people say that maybe our criteria for diagnosis have changed a little bit ... I don’t know if [the supplement] answers that. It’s a little bit of a controversy. But the positive spin on it would be that while the incidence rate is increasing, we’re able to catch it in time that the death rate is staying about the same."

The take home messages from the supplement include: cancer incidence is increasing in younger individuals, particularly younger women; the greatest melanoma mortality is seen among elderly men; and dermatologists have an important chance to improve surveillance of melanoma by reporting their data to registries, such as the SEER database.

Young Women

The study of melanoma in adolescents and young adults aged 15-39 years (J. Am. Acad. Dermatol 2011;65[suppl. 1]:S38-49) found the incidence of melanoma to be rising in that age group. "There have been a number of studies in this younger age group showing the incidence shooting up, especially among women," said Dr. Tsao. "This study substantiates previously published data."

According to Dr. Roenigk, it has been suggested that "the increased incidence in melanoma could just be due to people living longer ... but obviously with people under the age of 40 it’s not so much living longer, it’s probably behavioral or it’s environmental ... but not necessarily longevity."

Dr. Tsao noted that the increasing melanoma incidence in this age group "has implications for what we can do now on some regulatory level ... and for what we expect to happen in 20 years. Are we going to get a whole cohort of advanced-disease women because there is a lag time in the formation of [melanomas] ... It’s a cautionary tale for the future but it’s certainly a point of intervention now."

Tanning beds continue to be a source of controversy at all levels of government nationwide. The AAD, states, local organizations, and others are working to tackle the issue of access to tanning beds.

Education may prove even harder. "We have a lot of room to improve ... despite pretty heavy messaging ... people are either fatigued with the message or they have competing interests," said Dr. Tsao. "There are even more and more studies out there suggesting that even the long-wave ‘safer tans’ like UVA can cause the same types of genetic damage ... I’m not sure that the words ‘safe tan’ makes any sense. A lot of exposure even to long-wave UVA may lead to the chronic skin cancer environment in the skin."

Older Men

The other newer information asks who is dying from melanoma. "Overall, yes, young women are getting melanoma," but if you’re asking who is dying from melanoma, it is old men. You’ll see this theme throughout many of the articles," said Dr. Tsao. "Elderly men are getting to be the most susceptible group – it appears – for melanoma if you look at the death rates." In this age group the rates of melanoma mortality are much greater in men than in women (J. Am. Acad. Dermatol 2011;65[suppl. 1]:S78-86).

"This is going to have clinical impact down the line," Dr. Tsao noted. "Many of these [older] people have melanomas on the head and neck, which appear to have a worse prognosis." These tumors are thick, often nodular in subtype and with a lot of negative features in the pathology report. "We don’t really understand this phenotype – it may be the tumor, it may be the host, it may be the chronically sun-damaged skin surface."

However, "the question is how you get that group to be potentially screened – and how screening within this group is going to impact mortality," he noted. "We’re still optimistic that with proper screening, we can make a difference in mortality."

Dr. Tsao uses the mnemonic MENN (male, elderly, neck/scalp/trunk, nodular type melanoma) to thoroughly check for melanomas in this patient population, regardless of the reason for presentation.

Melanoma Registries

"One of the ways that we can study the burden of a skin disease is by having nationalized records. It doesn’t exist for most other skin diseases," said Dr. Tsao. "Still, most dermatologists in practice don’t think about registering their melanomas, even though this is one of the most codified disorders in all of dermatology ... maybe this is something that we need to work on ... the only way that we can make progress toward documenting the burden of skin disease is that we document the burden of skin disease."

There are likely a large number of melanomas that are diagnosed in the community and the question is whether those are getting recorded in a registry. "In most large hospitals or tertiary care centers, cancers undergo registration. But this may not be the case in private practice," Dr. Tsao said. "If we’re underestimating the burden of melanoma, then in some ways we’re shortchanging ourselves. Given the long-range surveillance, dermatologists are becoming the primary caretakers of melanoma patients in this country in terms of sheer volume ... dermatologists have an opportunity to detect at an early stage and to deflect these patients away from advanced disease."