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Melanoma: Risk Factors and Prevention

source: dermatlias.med.jhmi.edu

Public Health Community Advisory – Melanoma is a skin cancer. It is not the most common skin cancer, but it is the most deadly. It is the eighth most commonly diagnosed cancer in Nebraska for the period 1999-2008. Melanoma is seen much more often in Whites (especially those of Northern European ancestry living in sunny climates). The incidence of melanoma has been increasing by about 5% annually for fair-skinned Whites for many years. However, the National Cancer Institute says that “while skin cancer is less common in people with darker skin, people of color are at some risk for the disease. Unfortunately, African Americans are often diagnosed at an advanced stage, when there is less chance for a cure.” Because most melanomas are discovered early in their development and can be surgically removed, the five-year survival rate is over 90%. Yet, according to the Skin Cancer Foundation, “as few as 48% of melanomas in African Americans are diagnosed at an early stage, compared to 74% in Hispanics and 84% in Caucasians.”

The primary cause of melanoma is ultraviolet (UV) light exposure (mostly from sunlight) in susceptible individuals. Factors thought to increase the risk of developing melanoma are early age at significant UV light exposure, the intensity and duration of exposure, the degree of skin pigmentation, and the tendency to sunburn. The tendency to sunburn appears to put individuals at especially increased risk. Individuals with many moles (dark spots on the skin), especially if some are “abnormal”—either large, not symmetric, or have irregular borders or color variation—are also at higher risk of developing melanoma, as are individuals who have a tendency to freckle.

Skin melanomas are among the most preventable and treatable of all cancers. Reducing UV light exposure (for instance, avoiding sun exposure between 10 a.m. and 3 p.m., wearing protective clothing, and/or using sunscreens that effectively block both UV light types [“broad spectrum sunscreens”]) are the best methods for preventing the disease, and children in particular should have such protection. The American Cancer Society suggests that adults examine their skin monthly and have any suspicious lesions evaluated promptly by a physician.

Various education and research efforts have been made to reduce UV light exposure, especially for people who work outdoors and have long periods of sun exposure, such as agricultural workers. The UNMC College of Public Health Center for Agricultural Safety and Health is now an Agrisafe Network Nebraska Affiliate site. Agrisafe has been promoting the use of hats and sunscreens to protect against skin cancer; see for example the videos available at: http://agrisafe.org/farmers/skincancer/

While not as great a population exposure as sunlight, tanning beds work through UV light, and research has shown that people who use tanning beds are more likely to develop melanoma than those who do not. Persons otherwise at increased risk (fair-skinned, red-haired, those with freckles or multiple or abnormal moles) should avoid the use of tanning beds.

This article was written by James R. Anderson, associate dean for research in the UNMC COPH, and professor in the UNMC COPH Department of Biostatistics.

 

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