National Cancer Institute
A prominent dermatologist recently laid to rest the contention that the rise in the number of melanomas are a result of increased skin cancer screenings and better diagnostic tools, not from an increase in the disease itself.
In an interview at the American Academy of Dermatology’s annual meeting, Darrell S. Rigel, MD, clinical professor of dermatology at New York University Medical Center in New York City and a past president of the American Academy of Dermatology, dispelled what he calls “myth about the rise in melanoma.”
The numbers are indisputable. In 1930, the average American’s risk of developing melanoma in his lifetime was one in 1500. By 2004, that risk was one in 65. Today, the risk is one in 58 and by 2015, the risk will be one in 50 if present trends continue.
According to the Centers for Disease Control, a total of 68,720 Americans were diagnosed with melanoma in 2009, compared with 47,700 in 2000.
Skeptics attribute the increase in diagnoses to increased skin cancer screenings and to earlier diagnoses. Dr. Rigel disagrees and we find his reasoning highly credible.
Dr. Rigel uses prostate cancer as an example of how the numbers can fluctuate with increased screenings. When testing for prostate specific antigen (PSA) was introduced in the early 1990s, there was a sharp spike in the number of prostate cancer diagnoses. Then prostate cancer diagnoses dropped significantly from 1992-1995 after which they leveled off.
“Until PSA testing was introduced, we had no way to detect early prostate cancers, before symptoms developed. With PSA testing, there was a transient increase in case due to increased detection of preclinical (before symptoms) disease. But once those initial cases of prostate cancer were found, it was not diagnosed as often,” Rigel says.
Although skin cancer screenings became more readily accessible in the 1980s, no such trend is occurring with melanoma rates, Rigel says.
Melanoma Cases Underreported?
Dr. Rigel makes a strong case that the incidence of melanoma may in fact be underreported. That’s because of the way the National Cancer Institute counts cancer cases. It’s a hospital-based method. That is, the NCI counts cancer cases reported from hospitals. But melanoma is the only major cancer where patients aren’t always seen in the hospital.
“I often diagnose a patient in my office and excise the skin lesion in the office so the patient never even makes it to the hospital,” he says.
He also points to a 1991 study, published in the Journal of the American Academy of Dermatology, showed that up to 19% of cases in Massachusetts were never reported. A 1997 study in the same journal showed a 17% rate of underreporting in Iowa.
Preventing Melanoma
The bottom line is that melanoma is almost always preventable. Follow the steps outlined in SunAWARE to prevent skin cancer, including melanoma.
Be SunAWARE. Be safe.
(Note: This post was based upon a splendid interview conducted by WebMD with Dr. Rigel.)
