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
Mertz K, Lewis HC Jr, Meinert LA. Malignant melanoma of the
skin. NJ Med 1990;87:401-7.
National Institutes of Health. Sunlight, ultraviolet radiation
and the skin: Consensus Development Conference statement.
Bethesda, Maryland: National Institutes of Health, 1989.
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.
American Cancer Society. Cancer facts and figures--1989.
Atlanta: American Cancer Society, 1989.
Mackie RM. The role of sunlight in the etiology of cutaneous
malignant melanoma. Clin Exper Dermatol 1981;6:407-10.
Armstrong BK, Holman CD. Malignant melanoma of the skin. Bull
WHO 1987;65:245-52.
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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