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Progress in Chronic Disease Prevention Malignant Melanoma of the Skin -- New Jersey, 1979-1985

Each year, several thousand New Jersey residents are diagnosed with skin cancer. Although most types of skin cancer can be treated successfully, one--malignant melanoma--has a high mortality rate. This report summarizes a study by the New Jersey State Department of Health (NJSDH) that examined the incidence and mortality rates for malignant melanoma in New Jersey residents from 1979 through 1985 and compared those rates with U.S rates for the same period (1).

Incidence data were obtained from the New Jersey State Cancer Registry (NJSCR) and analyzed by the NJSDH's Data Applications Program. The melanoma incidence data include all cases reported to the NJSCR from hospitals, laboratories, and private practitioners and cases identified through New Jersey death certificate matching. The mortality data were extracted from the state's vital statistics mortality data tapes and included cases of malignant melanoma of the skin (International Classification of Diseases, Ninth Revision, rubrics 172.0-172.9) listed as the underlying cause of death. Incidence and mortality rates were age-adjusted to the 1970 U.S. population. National incidence rates were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute.* The mortality rates include the entire United States, age-adjusted to the 1970 U.S. population. Because incidence and mortality rates for blacks in New Jersey were low, they were not included in this analysis.

From 1979 through 1985, an average of 381 males and 324 females were diagnosed annually in New Jersey with malignant melanoma, and an average of 111 males and 79 females died each year from the disease. White males had the highest average incidence rate for the 7-year period (11.9 cases per 100,000, compared with 10.9 per 100,000 from SEER data) (Figure 1). The incidence rate for white females was 8.5 per 100,000 (compared with 8.8 per 100,000 from SEER) (Figure 1). Mortality rates for whites were higher for males than for females; the age-adjusted mortality rates for both sexes in New Jersey were higher than the national rates. The mortality rate was 3.4 per 100,000 for New Jersey males and 1.6 per 100,000 for New Jersey females; national mortality rates were 3.0 per 100,000 for males and 1.6 per 100,000 for females (3). In New Jersey, 73% of the melanomas were staged as local, compared with 78% in the SEER Program. The most common site for melanoma of the skin in white males was the trunk (47.9%), followed by the arm and shoulder (22.7%), face (12.3%), leg and hip (10.4%), and scalp and neck (6.7%). For white females, the most common site was the leg and hip (38.1%), followed by the arm and shoulder (24.0%), trunk (23.5%), face (10.1%), and scalp and neck (4.3%).

In response to this study, the NJSDH and the Medical Society of New Jersey are preparing a press release to the public and health-care community before the summer season emphasizing the dangers of excessive sun exposure, which has been linked to malignant melanoma (5). The NJSDH has advised all persons to follow the guidelines set by the National Institutes of Health (NIH) to prevent and reduce the risk for malignant melanoma and to take precautions against excessive sun exposure (2). Reported by: WE Parkin, DVM, ME Petrone, MD, DM Harlan, MS, BA Kohler, MPH, HC Lewis, MPH, Div of Epidemiology and Disease Control, Cancer Registry and Data Applications Programs, K Mertz, MD, K Spitalny, MD, State Epidemiologist, New Jersey State Dept of Health.

Editorial Note

Editorial Note: Since the 1970s, the incidence and mortality rates for malignant melanoma of the skin have increased steadily in the United States. From 1973 to 1985, the national mortality rate for melanoma of the skin rose 25.9%, a greater percentage increase for any neoplasm except lung cancer (3). During the same period, the mortality rate for white males in the United States increased 34.1%, the highest percentage increase of any cancer for this population (3). In 1989, an estimated 27,000 new cases of malignant melanoma will occur in the United States, and 6000 persons will die from the disease (4).

Melanoma has been associated with intermittent exposure to high-intensity ultraviolet radiation (5-7). The emphasis on suntanning and outdoor recreation in the United States may account for the high rate of increase in melanoma cases (4).

To minimize the risk for melanoma, persons should follow the NIH guidelines (2), which recommend 1) minimizing exposure to the sun between 10 a.m. and 3 p.m., when the sun's rays are most intense; 2) wearing a hat that protects the head and face and clothing that protects the back and shoulders from sunburn; 3) using a waterproof sunscreen with a sun protection factor of greater than or equal to 15 on exposed skin; and 4) consulting with a physician about medications that can increase sensitivity to ultraviolet light.

References

  1. Mertz K, Lewis HC Jr, Meinert LA. Malignant melanoma of the skin. NJ Med 1990;87:401-7.

  2. National Institutes of Health. Sunlight, ultraviolet radiation and the skin: Consensus Development Conference statement. Bethesda, Maryland: National Institutes of Health, 1989.

  3. National Institutes of Health. 1987 Annual cancer statistics review. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, 1988; NIH publication no. 88-2789.

  4. American Cancer Society. Cancer facts and figures--1989. Atlanta: American Cancer Society, 1989.

  5. Mackie RM. The role of sunlight in the etiology of cutaneous malignant melanoma. Clin Exper Dermatol 1981;6:407-10.

  6. Armstrong BK, Holman CD. Malignant melanoma of the skin. Bull WHO 1987;65:245-52.

  7. Armstrong BK. Epidemiology of malignant melanoma: intermittent or total accumulated exposure to the sun? J Dermatol Surg Oncol 1988;14:853-7.

    • The SEER Program comprises cases from nine population-based cancer registries throughout the United States.



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