MELANOMA DEATH
Melanoma can appear on normal skin, or it may begin as a mole or other area that has changed in appearance. Some moles that are present at birth may develop into melanomas.There are four major types of melanoma:
- Superficial spreading melanoma is the most common type of melanoma. It is usually flat and irregular in shape and color, with different shades of black and brown. It may occur at any age or body site, and is most common in Caucasians.
- Nodular melanoma usually starts as a raised area that is dark blackish-blue or bluish-red. However, some do not have any color.
- Lentigo maligna melanoma usually occurs in the elderly. It is most common in sun-damaged skin on the face, neck, and arms. The abnormal skin areas are usually large, flat, and tan with areas of brown.
- Acral lentiginous melanoma is the least common form of melanoma. It usually occurs on the palms, soles, or under the nails and is more common in African Americans.
Risks for melanoma include the following:
- Living in sunny climates or at high altitudes
- Long-term exposure to high levels of strong sunlight, because of a job or other activities
- One or more blistering sunburns during childhood
- Use of tanning devices
Other risk factors include:
- Close relatives with a history of melanoma
- Exposure to chemicals that can cause cancer, such as arsenic, coal tar, and creosote
- Presence of certain types of moles (atypical dysplastic) or multiple birthmarks
- Weakened immune system due to AIDS, some leukemias, organ transplant, medications used to treat illnesses such as rheumatoid arthritis
According to the Centers for Disease Control, in the United States, almost half (46%) of all melanoma deaths occur among men aged greater than or equal to 50 years. Possible factors that may contribute to the higher mortality among white men greater than or equal to 50 years of age than among women include biological features (i.e., a possible predisposition toward a more aggressive form of the disease), and gender differences in anatomic sites of malignant melanomas and self-discovery patterns. Specifically, back lesions, which may be more difficult to discover by self-inspection, are more prevalent among men. In addition, men may be less likely to discover melanoma on themselves than women. These findings may, in part, account for a higher percentage of men with more advanced melanomas than women (14% versus 10% regional and distant disease, respectively, p less than 0.0001) and a worse prognosis for back lesions for men than for women. These sex-specific differences should be considered in planning improved strategies to control and prevent melanomas.
Because skin cancer is external and visible, efforts to increase public and professional education about the early detection of melanomas may help to reduce mortality among groups at highest risk. For example, free screening programs sponsored by the American Academy of Dermatology have examined approximately 500,000 persons for melanoma and other skin cancers (American Academy of Dermatology, unpublished data, 1992). However, men have constituted only one third of all attendees, of whom only 15% were aged greater than or equal to 65 years.
Additional measures for physicians and other health-care providers include examination of the back and other anatomic sites that are difficult for patients to self-inspect for pigmented lesions. Also, physicians should indicate on patients' medical records an assessment of factors such as "changing moles," "higher than average number of moles," and "family history of melanoma" as a prompt for rapid, noninvasive visual examinations for skin cancer.