Deaths from Melanoma--United States, 1973-1992

Approximately three-fourths of all skin cancer-associated deathsare caused by melanoma. During 1973 to 1991, the incidence ofmelanoma increased approximately 4% each year. In addition, theincidence of melanoma is increasing faster than that of any othercancer. To characterize the distribution of deaths from melanomain the United States, the CDC analyzed national mortality datafor 1973 through 1992. This report by the Division of Cancer Preventionand Control, National Center for Chronic Disease Prevention andHealth Promotion, CDC, summarizes the results of that analysis.

Decedents for whom the underlying cause of death was melanoma(International Classification of Diseases, Adapted, Ninth Revision,codes 172.0-172.9) were identified from public-use mortality datatapes from 1973 through 1992. The denominators for rate calculationswere derived from US census population estimates. Rates were directlystandardized to the age distribution of the 1970 US populationand were analyzed by state, age group, sex, year, and race. Toincrease the precision of the rates presented, race was characterizedas white and all other races because approximately 98% of deathsfrom melanoma occurred among whites.

An Increase in the Death Rate

From 1973 through 1992, the overall percentage increase in therate of deaths from melanoma (34.1%) was the third highest ofall cancers; for males, the percentage increase for melanoma (47.9%)was the highest for all cancers. During the same period, the increasein the rate of deaths from melanoma was greater for white malesthan for other racial and sex groups (Figure 1). In 1992, therate of deaths from melanoma was 5.9 times higher for whites thanfor all other races (2.5 and 0.4 per 100,000 population, respectively)and 2.1 times higher for males than females (3.1 and 1.5, respectively).

To increase statistical precision, the rate of deaths from melanomaby state was aggregated for 1988 to 1992. In every state, therate of deaths from melanoma was substantially higher for whitesthan for persons of all other races. For whites, the age-adjusteddeath rate by state ranged from 2.2 to 5.0 per 100,000 populationfor males and 0.8 to 2.3 per 100,000 for females. Most statesthat are in the two highest death rate quartiles are not in thelower US latitudes where sun exposure is generally more intense.

During 1973-1975 and 1990-1992, death rates were highest for whitemen over the age of 50 (Figure 2). The death rate increased morewith age for males than for females during 1990 to 1992.

Editorial Note from the CDC

The findings in this report indicate that the rate of deaths frommelanoma was higher for whites than persons of all other races--afinding consistent with the more common occurrence of melanomaamong persons with lightly pigmented skin and an incidence amongwhites that is more than 10 times higher than that for blacks.Based on estimates by the American Cancer Society, during 1995an estimated 34,100 new cases of melanoma will be diagnosed and7,200 deaths will be caused by melanoma. The likelihood of survivalof patients with melanoma is substantially greater if the diseaseis detected early and treated. Early detection of thin lesionsis associated with improved prognosis and treatment outcome thanis detection of thicker, later-stage tumors.

Risk factors for melanoma related to ultraviolet radiation exposureinclude a history of sunburn or sun sensitivity, a tendency tofreckle, the presence of lightly pigmented skin, blue eyes, andblond or red hair. Other risk factors include a family or personalhistory of melanoma and the presence of a large number of molesor any atypical moles. Sources for exposure to ultraviolet radiationinclude sunlight and artificial light (eg, tanning booths), bothof which can cause acute sunburn. The increased risk among personswho sustain intermittent, acute sunburn at an early age (ie, <18 years) underscores the need for initiating prevention measuresearly in childhood.

Adults, particularly older men in whom rates of deaths from melanomaare highest, should be encouraged to perform periodic skin self-examinationor be examined by a family member to monitor the location, size,and color of a pigmented lesion or mole. The ABCD approach canbe used to assess pigmented lesions and represents mole asymmetry(A), border irregularity (B), nonuniform color (ie, pigmentation;C), and diameter > 6 mm (D).

Recommendations for preventing melanoma should emphasize reductionof direct exposure to the sun when sunburn is most likely to occur,especially from 10 am to 3 pm. Specific measures include wearinga broad-brimmed hat and clothes that protect sun-exposed areas,seeking shade when outdoors, using a sunscreen of sun protectionfactor > 15 that provides protection against ultraviolet Aand ultraviolet B radiation, and referring to the daily UltravioletIndex rating provided by the National Weather Service and otherorganizations when planning outdoor activities.

In 1994, the CDC implemented a program to assist in achievementof the national health objectives for the year 2000 for preventingskin cancer. Elements of the CDC program include funding supportfor state health departments to develop and implement preventionprojects aimed at parents and caregivers of young children; enhancingprevention messages for the public; initiating the developmentof school health curriculum guidelines; enhancing UltravioletIndex public health messages; and developing a public and professionaleducation plan for skin cancer prevention.

From Morbidity and Mortality Weekly Report, vol. 44, no.