Deaths from Melanoma -- United States, 1973-1992

Approximately three fourths of all skin cancer-associated deaths are caused by melanoma. During 1973-1991, the incidence of melanoma increased approximately 4% each year (1). In addition, the incidence of melanoma is increasing faster than that of any other cancer (2). To characterize the distribution of deaths from melanoma in the United States, CDC analyzed national mortality data for 1973 through 1992. This report 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 (3). The denominators for rate calculations were derived from U.S. census population estimates (4,5). Rates were directly standardized to the age distribution of the 1970 U.S. 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.

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 (6). 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 1988-1992. 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 for females Table_1. Most states that are in the two highest death rate quartiles are not in the lower U.S. latitudes where sun exposure is generally more intense Figure_2.

During 1973-1975 and 1990-1992, death rates were highest for white men aged greater than or equal to 50 years Figure_3. The death rate increased more with age for males than for females during 1990-1992. Reported by: Div of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: 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 (2) and an incidence among whites that is more than 10 times higher than that for blacks (1). Based on estimates by the American Cancer Society, during 1995 an estimated 34,100 new cases of melanoma will be diagnosed and 7200 deaths will be caused by melanoma (1). The likelihood of survival of melanoma is substantially greater if the disease is detected early and treated (2). Early detection of thin lesions is associated with improved prognosis and treatment outcome than is detection of thicker, later stage tumors (2).

Risk factors (2,7,8) 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 (e.g., tanning booths), both of which can cause acute sunburn. The increased risk among persons who sustain intermittent, acute sunburn at an early age (i.e., less than 18 years) underscores the need for initiating prevention measures early in childhood (9).

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 (2) to monitor 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 (i.e., pigmentation) ("C"), and diameter greater than 6 mm ("D") (1,2,8).

Recommendations for preventing melanoma should emphasize reduction of direct exposure to the sun when sunburn is most likely to occur, especially from 10 a.m. to 3 p.m. 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 greater than or equal to 15 that provides protection against ultraviolet radiation A and ultraviolet radiation B, and referring to the daily Ultraviolet Index * rating provided by the National Weather Service and others when planning outdoor activities.

In 1994, CDC implemented a program to assist in achievement of the national health objectives for the year 2000 for preventing skin cancer (10). 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. May is Melanoma/Skin Cancer Detection and Prevention Month. Additional information is available from the American Academy of Dermatology, 930 North Meacham Road, Schaumburg, IL 60173-4965.

References

1. American Cancer Society. Cancer facts and figures, 1995. Atlanta: American Cancer Society, 1995; publication no. 5008.95.

2. Koh HK. Cutaneous melanoma. N Engl J Med 1991;325:171-82.

3. NCHS. Vital statistics mortality data, underlying cause of death, 1973-1992 {Machine-readable public-use data tapes}. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1973-1992.

4. Bureau of the Census. 1970-1989 Intercensal population estimates by race, sex, and age {Machine-readable data files}. Washington, DC: US Department of Commerce, Bureau of the Census, nd.

5. Irwin R. 1990-1992 Postcensal population estimates by race, sex, and age {Machine-readable data files}. Alexandria, Virginia: Demo-Detail, 1993.

6. Ries LAG, Miller BA, Hankey BF, Kosary CL, Harras A, Edwards BK, eds. SEER cancer statistics review, 1973-1991: tables and graphs. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute, 1994; publication no. (NIH)94-2789.

7. Hartman AM, Goldstein AM. Melanoma of the skin. In: Miller BA, Ries LAG, Hankey BF, et al., eds. SEER cancer statistics review, 1973-1990. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute, 1993; publication no. (NIH)93-2789.

8. Marks R, Hill D, eds. The public health approach to melanoma control: prevention and early detection. Geneva: International Union Against Cancer, 1992.

9. Wiley HE. Ways to protect children from sun damage. The Skin Cancer Foundation Journal 1994;12:41,98.

10. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50213.

* The Ultraviolet Index, provided by the National Weather Service, is broadcast by television and print media in 58 U.S. cities and provides information on the intensity of the sun's rays during the solar noon hour. The index ranges from 0 to 10+ with greater than or equal to 10 indicating the most intense sunlight.

TABLE 1. Number and rate * deaths from melanoma +, by state, race, and sex
-- United States, 1988-1992
===============================================================================
                                                 Rate
                             --------------------------------------------------
                                      All        All        White    White
State                 No.    Total   white   other races &  males   females
-------------------------------------------------------------------------------
Alabama                 538   2.3     2.8        0.4         3.9      1.9
Alaska                   39   2.1     2.5         @          3.2      1.7
Arizona                 488   2.3     2.5        0.5         3.4      1.6
Arkansas                325   2.2     2.5        0.7         3.3      1.8
California            3,796   2.5     2.9        0.4         4.0      2.0
Colorado                444   2.6     2.7         @          3.6      2.0
Connecticut             436   2.2     2.3        0.5         2.9      1.9
Delaware                108   2.9     3.4         @          5.0      2.2
District of Columbia     38   1.1     2.4        0.4         4.3      0.8
Florida               2,210   2.4     2.6        0.4         3.9      1.6
Georgia                 731   2.2     2.7        0.6         3.8      1.9
Hawaii                   71   1.2     3.1        0.5         4.6      1.8
Idaho                   133   2.4     2.4         @          3.3      1.7
Illinois              1,241   1.9     2.1        0.3         2.9      1.5
Indiana                 662   2.1     2.2        0.3         3.1      1.5
Iowa                    385   2.1     2.2         @          2.9      1.6
Kansas                  356   2.4     2.5         @          3.5      1.7
Kentucky                452   2.1     2.3        0.4         3.1      1.5
Louisiana               378   1.7     2.2        0.3         3.1      1.5
Maine                   166   2.2     2.3         @          3.1      1.6
Maryland                565   2.3     2.7        0.4         3.8      1.9
Massachusetts           935   2.6     2.8         @          3.7      2.1
Michigan                902   1.8     2.0        0.3         2.8      1.3
Minnesota               493   2.0     2.1        0.9         2.6      1.6
Mississippi             269   1.8     2.4        0.5         3.6      1.5
Missouri                730   2.4     2.6        0.3         3.5      1.9
Montana                 115   2.4     2.5         @          3.0      2.0
Nebraska                212   2.2     2.3         @          3.0      1.7
Nevada                  161   2.5     2.6         @          3.3      2.0
New Hampshire           143   2.3     2.3         @          3.5      1.5
New Jersey            1,134   2.4     2.7        0.4         3.9      1.8
New Mexico              174   2.2     2.3         @          2.9      1.8
New York              2,169   2.0     2.3        0.4         3.3      1.6
North Carolina          956   2.5     3.1        0.4         4.1      2.3
North Dakota             65   1.5     1.5         @          2.2      1.0
Ohio                  1,321   2.1     2.3        0.5         3.2      1.5
Oklahoma                483   2.6     2.9        0.3         3.9      2.1
Oregon                  425   2.5     2.6         @          3.4      1.9
Pennsylvania          1,735   2.2     2.4        0.4         3.4      1.7
Rhode Island            138   2.1     2.2         @          3.3      1.4
Suth Carolina           394   2.1     2.7        0.2         4.1      1.7
South Dakota             85   2.0     2.1         @          2.8      1.5
Tennessee               662   2.3     2.6        0.5         3.6      1.8
Texas                 1,806   2.1     2.3        0.5         3.3      1.6
Utah                    213   2.9     3.0         @          4.0      2.0
Vermont                  72   2.4     2.4         @          3.7      1.3
Virginia                738   2.2     2.6        0.5         3.5      1.9
Washington              598   2.2     2.3        0.3         3.2      1.7
West Virginia           292   2.5     2.6         @          3.5      1.9
Wisconsin               549   1.9     2.0         @          2.7      1.4
Wyoming                  45   1.9     1.9         @          2.6      1.3

Total                31,579   2.2     2.5        0.4         3.4      1.7
-------------------------------------------------------------------------------
* Per 100,000 population, adjusted to the 1970 U.S. population.
+ International Classification of Diseases, Adapted, Ninth Revision, codes
  172.0-172.9
& Blacks and other races were combined for this analysis because of their small
  number of deaths from melanoma and the small population of these groups in
  some states.
@ Fewer than 100,000 persons in denominator or fewer than five deaths.
===============================================================================

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