PREVENTION AND EARLY DETECTION STRATEGIES FOR MELANOMA AND SKIN-CANCER - CURRENT STATUS

Skin cancer represents an increasingly urgent worldwide public health problem.(1) Estimates project almost a million (or more) new cases eac h year in the United States; this number is roughly equal to that of a ll other cancers combined.(2) The incidence of cutaneous melanoma, whi ch is mounting faster than that of any other cancer in white persons, nearly doubled from 1973 to 1990; in addition, the rise in melanoma mo rtality rates in white persons ranks second only to lung cancer.(3) Wh ile the overall 5-year melanoma survival rates in the United States ro se from 49% (in the early 1950s) to 82% (in the early 1990s), death ra tes more than doubled during the same time; these rates were driven up by the rising incidence.(1,4) This year in the United States, melanom a will strike 34 000 persons and kill 7200-part of an estimated 90 000 cases diagnosed worldwide.(5,6) Despite exciting advances in innovati ve treatment approaches (eg, immuno-therapy and gene therapy), metasta tic melanoma remains largely incurable.(1) Decades of research have no t only crystallized an understanding of the epidemiology, risk factors , and natural history of skin cancer but also have begun to stimulate international efforts to promote its prevention and control, In theory , the public health burden of melanoma and skin cancer could be lowere d through some combination of effective primary and secondary preventi on measures. Reduction of excessive sun exposure (primary prevention) could theoretically reduce the incidence, since experts hypothesize th at 90% of the cases of nonmelanoma skin cancer (NMSC) and two thirds o f the cases of melanoma may be attributed to excessive sunlight exposu re.(6,7) Primary prevention strategies can include personal behavior c hanges for individuals leg, minimizing UV exposure and using sunscreen ), as well as policy and environmental interventions for populations l eg, provision of shady areas and preservation of the ozone layer). Ear ly detection (secondary prevention) should increase melanoma cure rate s, since long-term survival figures of 92% for localized melanoma decl ine sharply to lower than 5% for metastatic disease.(3) Furthermore, t hese external, visible cancers have identifiable risk factors, should be readily recognizable by the public and health professionals alike, and are easily treated in the early stages.(8) We summarize the curren t state of melanoma and skin cancer control around the world.