Brown It, Don't Burn It

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Risk Factors

Numerous risk factors for the development of melanoma have been identified, including sun sensitivity, white skin, fair hair, light eyes, tendency to freckle, family history of melanoma, dysplastic nevi, increased numbers of typical nevi, large congenital nevi (Figure 1), and immunosuppression.4
4. American Academy of Dermatology. MelanomaNet. Accessed online November 9, 2004, at: http://www.skincarephysicians.com/melanomanet/ .

The risk associated with sun exposure is not completely clear. Although sun exposure is a risk factor for melanoma, cutaneous melanomas can arise frequently in areas of the body not exposed to the sun (Figure 2).

Sunburn and intermittent sun exposure increase the risk of melanoma, but cumulative and occupational sun exposure do not appear to increase risk.5
5. Helfand M, Krages KP. Counseling to prevent skin cancer: a summary of the evidence for the U.S. Preventive Services Task Force. Rockville, Md.: Agency for Healthcare Research and Quality, 2003. Accessed November 9, 2004, at: http://www.ahrq.gov/clinic/3rduspstf/ skcacoun/skcounsum.htm.

Sun exposure in childhood and having more than one blistering sunburn in childhood are associated with an increased risk of melanoma.6
6. Whiteman DC, Whiteman CA, Green AC. Childhood sun exposure as a risk factor for melanoma: a systematic review of epidemiologic studies. Cancer Causes Control 2001;12:69-82.


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Epidemiology

According to data from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute, from 1995 to 1999 the annual age-adjusted incidence of melanoma was 20 per 100,000 persons among whites.2

The incidence was higher in men (24.4 per 100,000 persons) than in women (16.8 per 100,000 persons).2 The lifetime risk of developing invasive melanoma is 2.04 percent for white men and 1.45 percent for white women; about one in 74 Americans will be diagnosed with melanoma.2
2. Ries LA, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L, et al., eds. SEER cancer statistics review, 1973-1999. Bethesda, Md.: National Cancer Institute, 2002. Accessed online November 9, 2004, at: http://seer. cancer.gov/csr/1973_1999/.
Melanoma affects a younger patient population than many malignancies. The median age at diagnosis is 57 years. Sixty-two percent of cases are diagnosed before patients reach 65 years of age, and the median age at death is 67 years. Melanoma is the sixth leading cause of cancer death in the United States. According to statistics from SEER, an average of 18.8 life-years are lost per melanoma death.2

Melanoma is much more common in whites than in non-whites. California Cancer Registry data from 1988 to 1993 show the average annual age-adjusted incidence rates per 100,000 persons were 17.2 in men and 11.3 in women for non-Hispanic whites; 2.8 (men) and 3.0 (women) for Hispanics; 0.9 (men) and 0.8 (women) for Asians; and 1.0 (men) and 0.7 (women) for blacks.3
3. Cress RD, Holly EA. Incidence of cutaneous melanoma among non- Hispanic whites, Hispanics, Asians, and blacks: an analysis of California cancer registry data, 1988-93. Cancer Causes Control 1997;8:246-52.