Revised 14 Februrary 2013
Melanoma is an important cancer in terms of individual person-years of life lost, since the incidence is over a broad age range, diagnosis frequently occurs in young adults, and at a time of intense family responsibility and financial commitment. However, melanoma is both potentially preventable (section 6.1) and curable (section 6.2), if detected early (section 3).
Link to Skin Cancer Atlas.
The incidence rates of malignant melanoma continue to increase in men over age 45 and women over age 65 in B.C., but have stabilized or are declining at younger ages. Mortality rates continue to increase in men and women over age 65. It is estimated that there will be over 800 new cases of malignant melanoma in B.C. in 2009, and over 4,500 new cases in Canada, per annum.
See BCCA cancer statistics.
Causes and Prevention
Epidemiologic studies have shown that excessive exposure to sunlight plays the major role in the development of melanoma. Intermittent exposure to intense sun exposure in recreational and vacation activities is the main hazard. Exposure to other sources of ultraviolet radiation, for example from sunbeds, also increases the risk. First exposure to sunbeds prior to age 35 carries a particular increased risk. Fair skinned individuals who tan poorly and burn readily are at the greatest risk. Other identifiable risk factors include the presence of dysplastic nevi, increased number of melanocytic nevi, and family history of melanoma.
As a public health measure everyone needs to be aware of the risks of excess sun exposure. These risks can be minimized through the reduction of intense exposures, particularly during summer and on vacations, by seeking shade, avoiding exposure during the middle hours of the day, wearing UV protective clothing and using sunscreens as described in the section on other skin cancers.
The skin cancer risk of sun tanning salons is well established and therefore should be discussed with the patients.
Screening of Average Risk People
General population screening for cutaneous malignant melanoma either by regular clinical assessment or by self-screening is not recommended, as no trials have demonstrated that such screening decreases mortality.
Surveillance of High Risk Individuals
Individuals at high risk are those with a previous melanoma or a strong family history of melanoma (2 or more first degree relatives with the disease), who may carry a p16(INK4A) germline mutation, predisposing to the disease, and those with atypical nevus syndrome (formerly Dysplastic Nevus Syndrome). Such individuals should be under regular (for example, annual) surveillance, ideally by a dermatologist.