Melanoma on the rise especially amongst the young

By Dr. Ananya Mandal, MDApr 2 2012

There is a sharp rise in young people getting skin cancer. Officials are warning against risk factors, specifically tanning salons, which women are more likely to use.

Women under 40 are hit hardest by the escalating incidence of melanoma, according to a Mayo Clinic study published in the April issue of Mayo Clinic Proceedings, out today. Researchers examined records from a decades-long database of all patient care in Olmsted County, Minn., and looked for first-time diagnoses of melanoma in patients 18-39 from 1970 to 2009. Melanoma cases increased eightfold among women in that time and fourfold for men, the authors say. However, death rates from melanoma fell during the same period, suggesting that early interventions may be helping to save some lives, said the researchers.

“We need to get away from the idea that skin cancer is an older person's disease,” says report co-author Jerry Brewer, a dermatologist at the Mayo Clinic in Rochester, Minn. The findings might be explained by gender-specific behaviors addressed in other studies, the authors wrote. “Young women are more likely than young men to participate in activities that increase risk for melanoma, including voluntary exposure to artificial sunlamps.”

The study is the latest evidence of a steady rise in skin cancer. A major government study published Wednesday reported that while new cases of many of the most common cancers are declining, melanoma cases are increasing. “We're very concerned about the melanoma rates and the damage done by early exposure to sun, but also the increasing use of tanning beds,” says physician Marcus Plescia, director of the division of cancer prevention for the Centers for Disease Control and Prevention.

“There is no such thing as a healthy baseline tan,” Brewer said. “Even though young people have more of an understanding of the detrimental effects of tanning they are still not changing their behavior and they are tanning just as much or more as they did way back in the '80s.”

Jennifer Stein, a dermatologist at New York University Langone Medical Center, agreed that indoor tanning is a likely culprit. “One possible explanation for this rapid increase in cases of melanoma may be the use of indoor tanning beds in teens and young adults, which has become so popular in recent years,” said Stein, who was not involved with the study. “It's important for people to protect their skin from ultraviolet exposure, and to check their skin for new or changing moles, which can be a sign of melanoma. The key to surviving melanoma is early detection.”

“The people most affected are not just Baby Boomers but actually young adults,” says Hopwood's dermatologist, Kavita Mariwalla, director of dermatological surgery at Beth Israel Medical Center in New York. “Tanning before prom or big events has become a 'norm' for many teenagers. What they don't know is that each time they visit a tanning booth, their risk of skin cancer rises.”

According to the National Institutes of Health, excess exposure to ultraviolet light increases risk for all skin cancers. UV light is invisible radiation that can damage DNA in the skin and can be generated by the sun, sunlamps and tanning beds.

Melanoma is the deadliest form of skin cancer, and is expected to cause 76,000 new cases and 9,100 deaths in the United States this year, according to the National Cancer Institute. Symptoms include changes in an existing mole or development of an unusual growth on your skin, according to the Mayo Clinic. People with fair skin are at higher risk. The authors noted that the population of Olmsted County is mostly white. Fair skin has less pigment to protect the body from UV radiation. Other risk factors: one or more severe sunburns as a child, an unusual number of moles, a family history of melanoma - and exposure to UV light.

Doctors urge people to limit sun exposure, use sunscreen, and check moles for the ABCDEs:

• Asymmetry,
• Border that is blurred or irregular,
• Colors that are varied within the same mole,
• Diameter of more than a pencil eraser,
• Elevation or evolution - signs that the mole is raised or is changing shape.

The Indoor Tanning Association defends tanning lamps. “There is no consensus among researchers regarding the relationship between melanoma skin cancer and UV exposure either from the sun or a sunbed,” says executive director John Overstreet. “I expect more from the Mayo Clinic. There is no direct link from their report to tanning beds.”