Death Rates of Malignant Melanoma Among White Men -- United States, 1973-1988

Since 1973, death rates for malignant melanoma (International Classification of Diseases, Ninth Revision, codes 172.0-172.9) have increased in the United States and other countries; this increase has occurred disproportionately among white men (1,2). To develop hypotheses on the etiology of this increase, the Boston University Schools of Medicine and Public Health and CDC reviewed data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute and other existing databases. This report summarizes patterns of malignant melanoma among whites in the United States from 1973 through 1988 and suggests possible causes for these patterns.*

National incidence and death rates were obtained from the SEER Program. The SEER Program comprises cases from population-based cancer registries throughout the United States** that represent an estimated 9.6% of the U.S. population. The SEER Program also publishes death rates based on a public-use data tape from CDC's National Center for Health Statistics.

From 1973 through 1988, the age-adjusted melanoma death rates (standardized to the 1970 U.S. population) for whites were higher for men than for women (3,4), and among men the death rate for malignant melanoma increased faster than for any other cancer (4). During this 16-year period, the overall increase in the death rate was 50% for men (2.2 to 3.3 per 100,000) compared with 21% for women (1.4 to 1.7 per 100,000) (3,4). The greatest rise in melanoma mortality occurred among men aged greater than or equal to 50 years, with a peak increase of 78% for men aged 80-84 years (3,4) (Figure 1). The SEER data indicate that incidence rates were nearly equal for white men and women aged 40-44 years (16.1 per 100,000 versus 16.5 per 100,000, respectively) but were higher for men aged 50-54 years than for women of the same age (24.9 per 100,000 versus 18.1 per 100,000, respectively) and more than double for men aged 65-69 years than for women in the same age group (41.6 per 100,000 versus 17.9 per 100,000, respectively) (4).

In addition, for cases diagnosed from 1981 through 1987, the 5-year survival rates were poorer for men than women (77% versus 87%, respectively). Reported by: AC Geller, MPH, HK Koh, MD, DR Miller, ScD, MB Mercer, MPH, RA Lew, PhD, Dept of Dermatology, School of Medicine; Section of Epidemiology and Biostatistics, School of Public Health, Boston University, Massachusetts. Div of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note:No single etiology has been identified as the cause of malignant melanoma. Instead, various factors have been associated with an increased risk for this cancer (e.g., sun exposure, the presence of many or unusual moles, and genetic predisposition) (5). In particular, the increase in recreational exposure to sunlight during this century has been suggested as a contributor to the increasing incidence of melanoma noted in this report.

In the United States, almost half (46%) of all melanoma deaths occur among men aged greater than or equal to 50 years (6). Possible factors that may contribute to the higher mortality among white men greater than or equal to 50 years of age than among women include biological features (i.e., a possible predisposition toward a more aggressive form of the disease) (7), and gender differences in anatomic sites of malignant melanomas and self-discovery patterns. Specifically, back lesions, which may be more difficult to discover by self-inspection, are more prevalent among men (8). In addition, men may be less likely to discover melanoma on themselves than women (9). These findings may, in part, account for a higher percentage of men with more advanced melanomas than women (14% versus 10% regional and distant disease, respectively, p less than 0.0001) (4) and a worse prognosis for back lesions for men than for women (8). These sex-specific differences should be considered in planning improved strategies to control and prevent melanomas.

Because skin cancer is external and visible, efforts to increase public and professional education about the early detection of melanomas may help to reduce mortality among groups at highest risk. For example, free screening programs sponsored by the American Academy of Dermatology have examined approximately 500,000 persons for melanoma and other skin cancers (American Academy of Dermatology, unpublished data, 1992). However, men have constituted only one third of all attendees, of whom only 15% were aged greater than or equal to 65 years.

Additional measures for physicians and other health-care providers include examination of the back and other anatomic sites that are difficult for patients to self-inspect for pigmented lesions. Also, physicians should indicate on patients' medical records an assessment of factors such as "changing moles," "higher than average number of moles," and "family history of melanoma" as a prompt for rapid, noninvasive visual examinations for skin cancer.

References

1. Swerdlow AJ. 1990 international trends in cutaneous melanoma. In: Davis DL, Hoel D, eds. Trends in cancer mortality in industrial countries. New York: New York Academy of Sciences, 1990;609:235-51.

2. Wagener DK. 1990 patterns of melanoma deaths in the United States. In: Davis DL, Hoel D, eds. Trends in cancer mortality in industrial countries. New York: New York Academy of Sciences, 1990;609:252-58.

3. Gloeckler-Ries LA, Hankey BF, Edwards BK, eds. Cancer statistics and review, 1973-1987. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health, 1990; NIH publication no. 90-2789.

4. National Cancer Institute. SEER Program: cancer incidence and mortality in the United States 1973-81. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health, 1984; NIH publication no. 85-1837.

5. Koh HK. Cutaneous melanoma. N Engl J Med 1991;325:171-82.

6. NCHS. Vital statistics mortality data, multiple cause-of-death detail (machine-readable public-use data tape). Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1987.

7. Loggie B, Ronan SG, Bean J, Das Gupta TK. Invasive cutaneous melanoma in elderly patients. Arch Dermatol 1991;127:1188-93.

8. Balch CM, Soong SJ, Shaw HM, Urist MM, McCarthy WH. An analysis of prognostic factors in 8500 patients with cutaneous melanoma. In: Balch C, Houghton A, Milton G, Sober A, Soong S. Cutaneous melanoma. 2nd ed. Philadelphia: JB Lippincott, 1992:165-87.

9. Koh HK, Miller DR, Geller AC, Clapp RW, Mercer MB, Lew RA. Who discovers melanoma? patterns from a population-based survey. J Am Acad Dermatol 1992 (in press).

• Because of limitations in the size of the sample of all other

races, the analysis and report present comparisons by sex and age among whites.

** From 1973 through 1988, the nine locations were Connecticut, Hawaii, Iowa, New Mexico, and Utah; and Atlanta, Detroit, San Francisco/Oakland, and Seattle/Puget Sound.

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