Screening for melanoma and other skin cancers

The rising incidence and mortality of malignant melanoma in many areas of the world is a growing public health concern.1 In the United States, incidence rates are rising faster for melanoma than for any other cancer, and mortality from melanoma is increasing faster than that of any other cancer except cancer of the lung.2 Furthermore, melanoma not uncommonly affects young adults, contributing to years of potential life lost.3 Early detection and treatment offer much potential for reducing mortality from melanoma. If detected when the lesion is thin (for example, less than 0.76 mm), melanoma has an associated 5-year survival probability of better than 95%.4 On the other hand, chances of metastases and death are much higher for persons with thicker lesions. In addition, the treatment for advanced melanoma has been frustrating, with metastatic disease generally incurable. For these reasons, efforts to control the mounting burden of melanoma have focused on early detection. Education and screening are the two means by which cancer may be detected and treated at an earlier stage. Education through publicity campaigns and other avenues may increase early detection by motivating those at increased risk to seek diagnostic examination for suspicious lesions (see the article by MacKie in this issue). This appears to be particularly promising for melanoma because it is detectable simply by visual inspection. There have been several published attempts to evaluate public education campaigns for melanoma control.