Increasing Burden of Melanoma in the United States

Abstract

It is controversial whether worldwide increases in melanoma incidence represent a true epidemic. Dramatic increases in incidence in the setting of relatively stable mortality trends have also been attributed to expanded skin screening and detection of biologically indolent tumors with low metastatic potential. To better understand how melanoma incidence trends varied by severity at diagnosis and factors relevant to screening access, we assessed recent United States incidence and mortality trends by histologic type, tumor thickness and area-level socioeconomic status (SES). We obtained population-based data regarding diagnoses of invasive melanoma among non-hispanic whites from nearly 291 million person-years of observation by the Surveillance Epidemiology and End Results (SEER) program (1992–2004). Age-adjusted incidence and mortality rates were calculated for SEER and a subset (California) for which small-area SES measure was available. Overall, melanoma incidence increased at 3.1% (p<0.001) per year. Statistically significant rises occurred for tumors of all histologic subtypes and thicknesses, including those >4mm. Melanoma incidence rates doubled in all SES groups over a 10-year period while melanoma mortality rates did not increase significantly. We conclude that screening-associated diagnosis of thinner melanomas cannot explain the increasing rates of thicker melanomas among low SES populations with poorer access to screening.

Responses to immune checkpoint inhibitors in nonagenarians

“…16 In particular, older males had a 157% increase in melanoma mortality between 1969 and 1999. [2][3] In one retrospective analysis, 17 overall mortality and disease-specific mortality at 5 y was statistically inferior in patients 70 y of age.…”

Association between melanoma thickness, clinical skin examination and socioeconomic status: Results of a large population‐based study

“…3 Adjusted Wald tests of significance of individual parameters after adjustment for other variables in the model. 4 For controls, clinical skin examination in the 3 yr before an allocated referent date.…”

“…3 Although mortality from melanoma appears to have stabilized over the past decade in Australia, mortality among men continues to increase in the United States. 4 Tumour thickness is an important prognostic marker, with the 5-year relative survival decreasing dramatically as thickness increases. 5 Having had a whole-body clinical skin examination (CSE) in the past 3 years has been shown to significantly reduce the risk of thick melanoma.…”

Photodynamic Agents with Anti-metastatic Activities

“…A comparison of EC 50 values for irradiated (+hν) versus non-irradiated samples (-hν) reveals the relative phototoxicity of each compound ( Table 1). The metal-free compound "DIGP" (1) shows no significant change in cytotoxicity upon irradiation (EC 50 ≈ 30 µM), whereas the metal-containing derivatives 2 -7 all exhibit minimal dark toxicity (EC 50 > 80 µM) and highly variable toxicity upon irradiation (EC 50 = 0.2 -80 µM, Table 1). Of all derivatives tested, Zn-DIGP exhibits the most potent phototoxicity, with more than a 400-fold decrease in EC 50 value (EC 50 = 0.16 µM) upon irradiation.…”

“…(1,2) While surgery remains the main treatment option for advanced malignancies,(3) early-stage melanoma and non-melanoma skin cancers can be treated with photodynamic therapy (PDT). (4-6) Photodynamic therapy involves utilization of photosensitizers that exhibit phototoxicity by two common mechanisms, Type 1 involves longlived triplet states of the photosensitizer that react directly with cellular components; Type 2 involves formation of singlet oxygen which triggers cell death.…”