Melanoma: Overview
Skin cancer is the most common form of cancer in the United States. It impacts millions of Americans each year and its incidence continues to rise. Most skin cancers are non-melanomas (basal cell and squamous cell skin cancers) that rarely spread and are highly curable. Exposure to ultraviolet (UV) radiation appears to be the chief preventable risk factor for non-melanoma skin cancer and may be responsible for more than 90% of cases.
The most serious form of skin cancer, melanoma, impacts fewer people each year but can be fatal. It has a high potential to metastasize but can be treated effectively when diagnosed early. According to the American Cancer Society (ACS), rates for melanoma are 10 times higher in whites than African Americans. Among whites, rates are more than 50% higher in men than in women. The ACS also reports that recently melanoma has been increasing in young white women and white adults age 65 and older.
Nearly 9,000 Americans died from melanoma in 2010. Mortality rates for melanoma in Colorado have been significantly higher than U.S. rates for several years. The 2000-2006 Colorado melanoma incidence rate was 18% higher for males than the U.S. rate, and 22% higher for females. In Colorado, melanoma survival varies substantially by stage, with a five-year survival rate of 90% for localized disease and 19% for distant metastatic disease (CCCR, 2004).
Over a 12- to 13-year span, data collected in Colorado shows a gender disparity between men and women in relation to melanoma incidence and death. From 1995 to 2006, the incidence rate was higher for men than for women. From 1995 to 2007, the death rate for melanoma was also higher for men than for women. For this reason, it is important for statewide prevention and early detection efforts to particularly target males.
Data indicate that non-melanoma skin cancer is related to cumulative UV exposure throughout life, whereas intense exposure (sunburns) in childhood may be a more important predictor for melanoma later in life. Studies indicate that even a few severe sunburns early in life may double the risk of malignant melanoma. For this reason, it is important to reduce the proportion of children who have had severe sunburns (i.e., blistering or painful burn lasting more than three days) during childhood or adolescence. Artificial tanning appears to also impact melanoma incidence. A recent study found that indoor tanning is associated with a 74% higher risk of developing melanoma. Research shows that people who use tanning devices may also have a significantly increased risk of squamous and basal cell skin cancers.
National and international authorities (AAD, AAP, ACS, ASHA, CDC, NCI, NASBE, and WHO) strongly recommend reducing UV exposure to prevent skin cancer, eye damage, and skin damage. And yet, in 2006, only 66% of adults in Colorado reported using at least one method of sun protection. For children, the rate was 73%. Further, about 40% of adults in Colorado reported having been sunburned in 2006. Nearly 51% of children experienced sunburns in the same time period.
Colorado requires special care for UV protection because of its high elevation and 300+ days of sunshine per year. UV intensity increases about 5% for every 1,000 feet gained in elevation. So, Denver's UV intensity is 26% higher than at sea level. Coloradans should be aware of the dangers of sun exposure year-round at high altitude and take appropriate precautions. Reflective surfaces such as fresh snow can reflect UV from the earth's surface and increase exposure up to an additional 90% on a bright sunny day. Preventive actions are strongly encouraged when the sun's rays are most intense during midday hours and during the high UV months of April through October.
Sun safety prevention programs are recommended in a wide range of environments across Colorado. Parents and caregivers are encouraged to limit sun exposure for infants and children. In addition, facilities providing services to children (e.g., child care centers, schools and recreation programs) are urged to create sun-safe environments and policies. Workplaces are also encouraged to implement sun protection policies and strategies for their employees, including educating them on the risks of UV exposure and providing shade, protective apparel and sunscreen.
Several simple ways to reduce UV exposure are recommended. These everyday precautions include:
In addition, individuals should avoid unnecessary UV exposure from artificial sources such as sunlamps and tanning beds. The WHO now recommends against the use of UV tanning devices for cosmetic purposes. WHO also recommends that no person under 18 use an artificial tanning device.