Melanoma rates keep rising, especially among young women
■ Regulations aimed at preventing youths from using tanning beds can be difficult to enforce, a dermatologist says.
Although physicians often discuss with patients the potential dangers of tanning and not wearing sunscreen, incidence of melanoma continues to rise, according to recent reports.
Even more concerning for health professionals is that the greatest increase seems to be occurring among adolescents and young adults, particularly in females, says a study in the April issue of Mayo Clinic Proceedings.
“There is no such thing as a healthy tan, because you can’t get tanned without damaging your skin first,” said Jerry D. Brewer, MD, lead author of the study and assistant professor of dermatology at Mayo Clinic in Rochester, Minn. “That damage is what makes you more likely to get skin cancer later in life.”
The study shows that between 1970 and 2009, melanoma increased eightfold among women ages 18 to 39 and fourfold in men who lived in Olmstead County, Minn. Although the data are for a largely white population, the findings are significant for doctors across the country, because they mirror the national trend that melanoma is increasing, particularly among young women, Dr. Brewer said.
“We anticipated that we’d find rising rates, particularly among young women, but we were surprised to see such a dramatic increase in incidence,” he said.
He added that the rising cancer rate, particularly for young women, probably is being driven by use of indoor tanning beds.
Ultraviolet radiation is a known carcinogen, but indoor tanning is particularly dangerous, because tanning beds can emit 10 to 15 times more UV radiation than the midday sun, health professionals say.
Regulations aimed at preventing youths from using indoor tanning beds, such as those that require parents to sign a consent form for teens younger than 18, have been implemented at state and local levels. But some tanning salons do not follow the rules, making the regulations difficult to enforce, said Bernard A. Cohen, MD, director of pediatric dermatology at Johns Hopkins Children’s Center in Baltimore.
The American Medical Association adopted policy in 2006 to develop model legislation prohibiting minors from indoor tanning facilities.
Some dermatologists say primary care physicians play a critical role in reversing the trend of rising melanoma rates because they see patients on a regular basis. Dr. Brewer recommends that primary care physicians examine patients’ skin during office visits. For example, when listening to a patient’s lungs, doctors can look at the individual’s back for suspicious marks, he said.
Other areas Dr. Brewer recommends physicians examine are the scalp, face, arms, torso, legs and feet. If a mole or other mark looks suspicious, doctors should refer the patient to a dermatologist, he said.
During an annual exam, primary care physicians should spend a few minutes talking to patients and their parents about skin cancer prevention, said Dr. Cohen, chair of the American Academy of Pediatrics’ section on dermatology. He said such conversations are particularly important for families of young children to help them establish healthy behavior early in life.
Dr. Cohen said physicians should inform patients about risk factors of developing the disease, which include having a family history of melanoma; using tanning beds; having fair skin, light hair and eyes; and burning easily.
Doctors also should recommend that patients limit their time in the sun, particularly during midday, when UV rays are strongest and most harmful, according to dermatologists. People who plan to spend time in the sun should wear a broad-spectrum, water-resistant sunscreen with a sun protection factor of 30 or more, the American Academy of Dermatology says.
Prevalence of melanomas
In 2007, 58,094 people in the U.S. were diagnosed with melanomas and 8,461 died of skin cancer, according to the Centers for Disease Control and Prevention. Incidence of melanoma in white females 15 to 39 has been rising 3% annually since 1992, according to an AAP report published in the March 2011 issue of Pediatrics.
For the Mayo Clinic study, researchers examined Rochester Epidemiology Project data on 256 adults 18 to 39 who lived in Olmsted County in Minnesota and received their first diagnosis of melanoma between Jan. 1, 1970, and Dec. 31, 2009. Seventy-percent of the patients were female and 30% were male.
Data show there were 16 melanoma diagnoses between 1970-79 compared with 129 diagnoses between 2000-09. Among women, cancer was most commonly found on their lower extremity (31%); upper extremity (21%); back (19%); and neck, shoulder, chest and breast (8%).
For men, melanoma was most frequently identified on the back (30%); upper extremity (16%); neck, shoulder and head (13%); and lower extremity (11%).
By the end of the study, 12 patients had died, including eight from melanoma.
“The message to primary care physicians is take the time to look at the skin. The second message is that young people are not immune to skin cancer,” Dr. Brewer said.