Wednesday, October 5, 2011

Skin Cancer Facts



·         GENERAL
·         Skin cancer is the most common form of cancer in the United States. More than 3.5 million skin cancers in over two million people are diagnosed annually.1
·         Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.2
·         One in five Americans will develop skin cancer in the course of a lifetime.3
·         Over the past 31 years, more people have had skin cancer than all other cancers combined.4
·         Nearly 800,000 Americans are living with a history of melanoma and 13 million are living with a history of nonmelanoma skin cancer, typically diagnosed as basal cell carcinoma or squamous cell carcinoma.5
·         Actinic keratosis is the most common precancer; it affects more than 58 million Americans.6 Approximately 65 percent of all squamous cell carcinomas arise in lesions that previously were diagnosed as actinic keratoses. In patients with a history of two or more skin cancers, 36 percent of basal cell carcinomas arise in lesions previously diagnosed as actinic keratoses.7
·         Basal cell carcinoma (BCC) is the most common form of skin cancer; an estimated 2.8 million are diagnosed annually in the US.8 BCCs are rarely fatal, but can be highly disfiguring if allowed to grow.
·         Squamous cell carcinoma (SCC) is the second most common form of skin cancer.9 An estimated 700,000 cases are diagnosed each year in the US,10 resulting in approximately 2,500 deaths.2
·         Between 40 and 50 percent of Americans who live to age 65 will have either skin cancer at least once.11
·         About 90 percent of nonmelanoma skin cancers are associated with exposure to ultraviolet (UV) radiation from the sun.12
·         Treatment of nonmelanoma skin cancers increased by nearly 77 percent between 1992 and 2006.13
·        

MELANOMA
·         One person dies of melanoma every hour (every 62 minutes).2
·         One in 55 people will be diagnosed with melanoma during their lifetime.14
·         Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old.15
·         The survival rate for patients whose melanoma is detected early, before the tumor has penetrated the skin, is about 99 percent.16 The survival rate falls to 15 percent for those with advanced disease.2
·         The vast majority of mutations found in melanoma are caused by ultraviolet radiation.12
·         The incidence of many common cancers is falling, but the incidence of melanoma continues to rise at a rate faster than that of any of the seven most common cancers.17 Between 1992 and 2004, melanoma incidence increased 45 percent, or 3.1 percent annually.18
·         An estimated 123,590 new cases of melanoma will be diagnosed in the US in 2011 — 53,360 noninvasive (in situ) and 70,230 invasive, with nearly 8,790 resulting in death.19
·         Melanoma accounts for less than five percent of skin cancer cases,20 but it causes more than 75 percent of skin cancer deaths.21
·         Survival with melanoma increased from 49 percent (1950 – 1954) to 92 percent (1996 – 2003).22
·         Melanoma is the fifth most common cancer for males and sixth most common for females.2
·         Women aged 39 and under have a higher probability of developing melanoma than any other cancer except breast cancer.2
·         About 65 percent of melanoma cases can be attributed to ultraviolet (UV) radiation from the sun.23
·         One or more blistering sunburns in childhood or adolescence more than double a person’s chances of developing melanoma later in life.24
·         A person’s risk for melanoma doubles if he or she has had more than five sunburns at any age.25
·         Survivors of melanoma are about nine times as likely as the general population to develop a new melanoma.26
·        
MEN/WOMEN
·         The majority of people diagnosed with melanoma are white men over age 50.14
·         One in 39 Caucasian men and one in 58 Caucasian women will develop melanoma in their lifetimes.2,27
·         Approximately 39,000 new cases of melanoma occur in men each year in the US, and 29,000 in women.2
·         Approximately 5,700 deaths from melanoma occur in men each year in the US, and 3,000 in women.2
·         Five percent of all cancers in men are melanomas; four percent of all cancers in women are melanomas.2
·         Adults over age 40, especially men, have the highest annual exposure to UV.28
·         Melanoma is one of only three cancers with an increasing mortality rate for men, along with liver cancer and esophageal cancer.29,27
·         Caucasian men over age 65 have had an 8.8 percent annual increase in melanoma incidence since 2003, the highest annual increase of any gender or age group.30
·         Between 1980 and 2004, the annual incidence of melanoma among young women increased by 50 percent, from 9.4 cases to 13.9 cases per 100,000 women.31
·         The number of women under age 40 diagnosed with basal cell carcinoma has more than doubled in the last 30 years; the incidence of squamous cell carcinoma among women under age 40 has increased almost 700 percent.32
·         Until age 39, women are almost twice as likely to develop melanoma as men. Starting at age 40, melanoma incidence in men exceeds incidence in women, and this trend becomes more pronounced with each decade.29
·        
INDOOR TANNING
·         Ultraviolet radiation (UVR) is a proven human carcinogen.33 Currently tanning beds are regulated by the FDA as Class I medical devices, the same designation given elastic bandages and tongue depressors.34
·         The International Agency for Research on Cancer, an affiliate of the World Health Organization, includes ultraviolet (UV) tanning devices in its Group 1, a list of the most dangerous cancer-causing substances.35Group 1 also includes agents such as plutonium, cigarettes, and solar UV radiation.36
·         Frequent tanners using new high-pressure sunlamps may receive as much as 12 times the annual UVA dose compared to the dose they receive from sun exposure.37
·         Ten minutes in a sunbed matches the cancer-causing effects of 10 minutes in the Mediterranean summer sun.38
·         Nearly 30 million people tan indoors in the U.S. every year39; 2.3 million of them are teens.40
·         On an average day, more than one million Americans use tanning salons.41
·         Seventy-one percent of tanning salon patrons are girls and women aged 16-29.42
·         Indoor ultraviolet (UV) tanners are 74 percent more likely to develop melanoma than those who have never tanned indoors.43
·         People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma.44
·         The indoor tanning industry has an annual estimated revenue of $5 billion.40

·         PEDIATRICS
·         Melanoma accounts for up to three percent of all pediatric cancers.45
·         Between 1973 and 2001, melanoma incidence in those under age 20 rose 2.9 percent.46
·         Melanoma is seven times more common between the ages of 10 and 20 than it is between birth and 10 years.47
·         Diagnoses — and treatment — are delayed in 40 percent of childhood melanoma cases.32
·         Ninety percent of pediatric melanoma cases occur in girls aged 10-19.46

·         ETHNICITY
·         Asian American and African American melanoma patients have a greater tendency than Caucasians to present with advanced disease at time of diagnosis.48
·         Skin cancer comprises one to two percent of all cancers in African Americans and Asian Indians.49
·         While melanoma is uncommon in African Americans, Latinos, and Asians, it is frequently fatal for these populations.48
·         As few as 48 percent of melanomas in African Americans are diagnosed at an early stage, compared to 74 percent in Hispanics and 84 percent in Caucasians.50
·         The overall melanoma survival rate for African Americans is only 77 percent, versus 91 percent for Caucasians.22
·         Melanomas in African Americans, Asians, Filipinos, Indonesians, and native Hawaiians most often occur on non-exposed skin with less pigment, with up to 60-75 percent of tumors arising on the palms, soles, mucous membranes and nail regions.51
·         Basal cell carcinoma (BCC) is the most common cancer in Caucasians, Hispanics, Chinese, Japanese, and other Asian populations.51
·         Squamous cell carcinoma (SCC) is the most common skin cancer among African Americans and Asian Indians.52
·         Squamous cell carcinomas in African Americans tend to be more aggressive and are associated with a 20-40 percent risk of metastasis (spreading).51
·         Skin cancer represents approximately 2-4 percent of all cancers in Asians.51
·         Among non-Caucasians, melanoma is a higher risk for children than adults: 6.5 percent of pediatric melanomas occur in non-Caucasians.46
·        
AGING/SUN DAMAGE
·         Up to 90 percent of the visible changes commonly attributed to aging are caused by the sun.53
·         Contrary to popular belief, 80 percent of a person’s lifetime sun exposure is not acquired before age 18; only about 23 percent of lifetime exposure occurs by age 18.28

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Lifetime UV Exposure in the United States
Ages
Average Accumulated Exposure*
1-18
22.73 percent
19-40
46.53 percent
41-59
73.7 percent
60-78
100 percent
*Based on a 78 year lifespan
·        
TREATMENT COSTS
·         In 2004, the total direct cost associated with the treatment for nonmelanoma skin cancer was $1.5 billion.54
·         The number of nonmelanoma skin cancers in the Medicare population went up an average of 4.2 percent every year between 1992 and 2006.1
·         In adults 65 or older, melanoma treatment costs total about $249 million annually. About 40 percent of the annual cost for melanoma goes to treating stage IV (advanced) cancers, though they account for only three percent of melanomas. 55
·        
REFERENCES
·         Rogers, HW, Weinstock, MA, Harris, AR, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol 2010; 146(3):283-287.
·         American Cancer Society. Cancer Facts & Figures 2010. Link. Accessed January 24, 2011.
·         Robinson, JK. Sun exposure, sun protection, and vitamin D. JAMA 2005; 294:1541-43.
·         Stern, RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol 2010; 146(3):279-282.
·         Altekruse SF, Kosary CL, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2007, Link. Accessed January 24, 2011.
·         The Lewen Group, Inc. The burden of skin diseases 2005. The Society for Investigative Dermatology and The American Academy of Dermatology Association. 2005.
·         Criscione, VD, Weinstock, MA, Naylor, MF, Luque, C, Eide, MJ and Bingham, SF. Actinic keratoses natural history and risk of malignant transformation in the Veterans Affairs Tropical Tretinoin Chemoprevention Trial. Cancer 2009; 115: 2523-2530.
·         Rogers, Howard. “Your new study of nonmelanoma skin cancers.” Email to The Skin Cancer Foundation. March 31, 2010.
·         Squamous Cell Carcinoma. American Academy of Dermatology. Link. Accessed November 1, 2010.
·         Rogers, Howard. “Your new study of nonmelanoma skin cancers.” Email to The Skin Cancer Foundation. April 1, 2010.
·         Sun Protection. Cancer Trends Progress Report – 2009/2010 Update. National Cancer Institute. Link. Accessed November 1, 2010.
·         Pleasance ED, Cheetham RK, Stephens PJ, et al. A comprehensive catalogue of somatic mutations from a human cancer genome. Nature; 2009; 463:191-196.
·         Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol2010; 146(3):279-282.
·         National Cancer Institute. SEER Stat Fact Sheets: Melanoma of the Skin. Link. Accessed January 24, 2011.
·         Bleyer A, O’Leary M, Barr R, Ries LAG (eds): Cancer epidemiology in older adolescents and young adults 15 to 29 years of age, including SEER incidence and survival: 1975-2000. Bethesda, MD: National Cancer Institute; 2006.
·         Huang CL, Halpern AC. Management of the patient with melanoma. In: Rigel DS, Friedman RJ, Dzubow LM, Reintgen DS, Bystryn J-C, Marks R, eds. Cancer of the Skin. New York, NY: Elsevier Saunders; 2005:265-75.
·         Ries LAG, Melbert D, Krapcho M, Stinchcomb DG, Howlader N, Horner MJ, et al. (eds). SEER cancer statistics review, 1945-2005. Bethesda, MD: National Cancer Institute; Link. Accessed January 24, 2010.
·         Linos E, Swetter SM, Cockburn MG, Colditz GA, Clarke CA. Increasing burden of melanoma in the United States.J Invest Dermatol 2009 July; 129(7):1666-1674.
·         American Academy of Dermatology. Melanoma Fact Sheet. Link. Accessed November 1, 2010.
·         American Cancer Society. Melanoma Skin Cancer Overview. Link. Accessed November 1, 2010.
·         The Burden of Skin Cancer. National Center for Chronic Disease Prevention and Health Promotion. Link. Accessed November 1, 2010.
·         Ries LAG, Melbert D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, et al. (eds). SEER Cancer Statistics Review, 1975-2004. Bethesda, MD: National Cancer Institute; Link. Accessed January 24, 2011.
·         Armstrong BK, Kricker A. How much melanoma is caused by sun exposure? Mel Res 1993 December 3(6):395-401.
·         Lew RA, Sober AJ, Cook N, Marvell R, Fitzpatrick TB. Sun exposure habits in patients with cutaneous melanoma: a case study. J Dermatol Surg Onc 1983; 12:981-6.
·         Pfahlberg A, Kolmel KF, Gefeller O. Timing of excessive ultraviolet radiation and melanoma: epidemiology does not support the existence of a critical period of high susceptibility to solar ultraviolet radiation-induced melanoma. Brit J Dermatol March 2001; 144:3:471.
·         Bradford PT, Freedman DM, Goldstein AM, Tucker MA. Increased risk of secondary primary cancers after a diagnosis of melanoma. Arch Dermatol 2010; 146(3):265-272.
·         Jemal A, Siegel R, Xu J, Ward E. Cancer statistics 2010. CA-Cancer J Clin 2010. Link. Accessed November 1, 2010
·         Godar DE, Urbach F, Gasparro FP, Van der Leun JC. UV doses of young adults. Photochem Photobiol 2003; 77(4):453-457.
·         Jemal A, Siegel R, Ward E, et al. Cancer Statistics 2008. CA-Cancer J Clin 2008; 58:76.
·         National Cancer Institute. A snapshot of melanoma. National Cancer Institute. Link; updated Sept 2009; accessed Oct 25 2010.
·         Purdue, MP, Freeman, LEB, Anderson WF, Tucker, MA. Recent trends in incidence of cutaneous melanoma among US Caucasian young adults. J Invest Dermatol 2008; 128:2905-2908.
·         Christenson LJ, Borrowman TA, Vachon CM, et al. Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years. JAMA 2005; 294(6):681-690.
·         IARC, 2010, Agents Classified by the IARC Monographs’, Volumes 1-100; Link. Accessed January 25, 2011.
·         US Food and Drug Administration. Learn if a medical device has been cleared by FDA for marketing. FDA. Link. Accessed October 25, 2010.
·         IARC Working Group. Special report: policy. A review of human carcinogens—part D: radiation. The Lancet2009; 10:751-752.
·         El Ghissassi, F. et al., A review of human carcinogens—part D: radiation. Lancet Oncol 2009; 10(8):751-2.
·         Report on Carcinogens, Eleventh Edition; U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. U.S. Department of Health & Human Services. Link. Accessed January 24, 2011.
·         World Health Organization. Sunbeds. World Health Organization. 2010. Link. Accessed October 25, 2010.
·         Kwon HT, Mayer JA, Walker KK, Yu H, Lewis EC, Belch GE. Promotion of frequent tanning sessions by indoor tanning facilities: two studies. J Am Acad Dermatol 2003; 46:700-5.
·         Demierre MF. Time for the national legislation of indoor tanning to protect minors. Arch Dermatol 2003; 139:520-4.
·         Spencer JM, Amonette RA. Indoor tanning: Risks, benefits, and future trends. J Am Acad Dermatol 1995; 33:288-98.
·         Swerdlow AJ, Weinstock MA. Do tanning lamps cause melanoma? An epidemiologic assessment. J Amer Acad Dermatol 1998; 38:89-98.
·         Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM. Indoor tanning and risk of melanoma: a case-control study in a highly-exposed population. Cancer Epidem Biomar Prev 2010 June; 19(6):1557-1568.
·         Karagas MR, Stannard VA, Mott LA, Slattery MJ, Spencer SK, and Weinstock MA. Use of tanning devices and risk of basal cell and squamous cell skin cancers. J Natl Cancer Inst 2002; 94:224; doi:10.1093/jnci/94.3.224.
·         Ferrari A, Bono A, Baldi M, et al. Does melanoma behave differently in younger children than in adults? A retrospective study of 33 cases of childhood melanoma from a single institution. Pediatrics 2005; 115:649-57.
·         Strous JJ, Fears TR, Tucker MA, Wayne AS. Pediatric melanoma: risk factor and survival analysis of the surveillance, epidemiology and end results database. J Clin Oncol 2005; 23:4735-41.
·         Conti EM, Cercato MC, Gatta G, et al. Childhood melanoma in Europe since 1978: a population-based survival study. Eur J Cancer 2001; 37:780-4.
·         Cress RD, Holly EA. Incidence of cutaneous melanoma among non-Hispanic whites, Hispanics, Asians, and blacks: an analysis of California cancer registry data, 1988-93. Cancer Causes Control 1997; 8:246-52.
·         Gloster HM, Neal K. Skin cancer in skin of color. J Amer Acad Dermatol 2006; 55:741-60.
·         Hu S, Soza-Vento RM, Parker DF, Kirsner RS. Comparison of stage at diagnosis of melanoma among Hispanic, black, and white patients in Miami-Dade County, Florida. Arch Dermatol 2006 Jun; 142(6):704-8.
·         Gloster HM, Neal K. Skin Cancer in Skin of Color. J Amer Acad Dermatol 2006; 55:741-60.
·         Halder RM, Bridgeman-Shah S. Skin cancer in African Americans. Cancer 1995; 75(2 suppl):667-673. Dhir A, Orengo I, Bruce S, Kolbusz RV, Alford E, Goldberg L. Basal cell carcinoma on the scalp in an Indian patient. Dermatol Surg1995 Mar; 21(3):247-250.
·         U.S. Environmental Protection Agency. Health effects of overexposure to the sun. Link. Updated July 1, 2010. Accessed January 25, 2011.
·         Bickers DR, Lim HW, Margolis D et al. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Amer Acad Dermatol 2006; 55(3):490-500.
·         Chen C, et al. Economic burden of melanoma in the elderly population. Population-based analysis of the surveillance, epidemiology, and end results (SEER)—Medicare data. Arch Dermatol 2010; 146(3):249-256.
·         These facts and statistics have been reviewed by David Polsky, MD, Assistant Professor of Dermatology and Pathology, New York University Medical Center and Steven Q. Wang, MD, Director of Dermatologic Surgery and Dermatology, Memorial Sloan-Kettering Cancer Center, Basking Ridge, NJ.



This page was last modified on 5 October 2011 at 08:10.