The Increasing Incidence of Cutaneous Malignant Melanoma (CMM) In Ireland
How dangerous is CMM to the Irish population?
On average each year, about 375 new cases of malignant melanoma of the skin are diagnosed in Ireland each year, 235 in females, and 140 in males. Every year about 60 people in Ireland die of CMM, of these about 32 are female and 28 are male. This makes CMM the 6th most frequent category of malignant cancer in females, but only the 12th most frequent in males. European-age-standardised rates show it is also significantly higher among females than males, by about 52%. On average, an Irish female is estimated to have a 1-in-100 chance of developing this cancer by age 74, while males a 1-in-150 chance. CMM is now the most common cancer amongst Irish women aged 20-29 years. Irish females also have the third highest number of cases of this form of skin cancer in the EU, while Irish males have the sixth highest out of 15 other European nations. (EUCAN study Ferlay et al 1999). Rates of CMM amongst males in Northern Ireland are significantly higher than males in RoI (about 14%). Within the EU, a north-south gradient is evident with melanoma rates higher in the more northerly countries, especially Sweden. This is consistent with the hypothesis that intermittent sunlight exposure in sun-sensitive individuals may be a critical factor in melanoma development.
The condition becomes a significant cancer from about age 20 or 25 onwards and based on All-Ireland data, rates appear to rise gradually to about age 50, with a steeper increase in rates thereafter, reaching a peak in age-classes from 75 years onwards. Rates are substantially higher among females than males in all age-classes between 15 and 69 years, especially in the range 15-34 years. Although patterns are broadly consistent between NI and RoI, the age-profile of NI patients indicates, on average, earlier occurrence. It is interesting that mortality rates with European Age Standardised Incidence Rates (EASRs) do not differ significantly between males and females, despite higher incidence rates in females, thus reflecting lower average survival rates in males. On average, the risk of dying from melanoma of the skin in Ireland before age 75 is presently estimated to be 1 in 770 for women and 1 in 800 for men.
Risk Factors for Melanoma
Family history of melanoma
Dysplastic nevi
History of melanoma
Weakened immune system
Many ordinary moles (more than 50)
Ultraviolet (UV) radiation
Severe, blistering sunburns
Freckles
Fair skin
Diagnosis
Because melanoma usually begins on the surface of the skin, a trained health care worker often can detect it at an early stage with a total skin examination. A monthly skin self-exam is important for people who have any of the known risk factors, especially those with dysplastic naevi or those with a very large number of ordinary moles who are at an increased risk of developing a melanoma. A new scanning machine SolarScan, which can detect malignant melanomas early in their course without requirement for a biopsy has recently been launched in Australia. The new device works by capturing an image of a patient’s skin lesion and it was developed over a period of eight years. It apparently can diagnose a melanoma before it exhibits features detectable in a routine clinical examination. Around 1,000 Australians and 1,600 people in the UK are killed each year by melanoma. If detected early, melanoma has a cure rate of almost 100 per cent, however, late detection (melanoma > 3 millimetres deep) results in only a 59 per cent survival rate.
Doing a skin self-examination
(1) Stand in front of a full-length mirror in a well-lighted room, after a bath or shower and use a hand-held mirror to look at hard-to-see areas.
(2) Begin with the face and scalp and work downward. Check the head, neck, shoulders, back, chest, and be sure to check the front, back, and sides of the arms and legs. Check the groin, palms, fingernails, the soles of the feet, the toenails, and the area between the toes. A friend or relative may be able to help inspect areas such as the scalp and neck..
(3) Be aware of where your moles are and how they look. Look for any signs of change in outline, shape, size, colour (especially black) or feel of an existing mole. Also, note any new, unusual, or “ugly-looking” moles. Remember to check moles carefully during times of hormone changes, such as adolescence, pregnancy, and menopause. It is known that as hormone levels change, moles may also change.
Prevention of Melanoma
UV radiation from the sun and from sunlamps and tanning booths damages the skin and can lead to melanoma and other types of skin cancer. The intensity of UV radiation from the sun is greatest in the summer, particularly during midday hours. A simple rule is to avoid the sun or protect your skin whenever your shadow is shorter than you are. People who work or play in the sun should wear protective clothing, such as a hat and long sleeves. Many doctors believe sunscreens may help prevent melanoma, especially those that reflect, absorb, and/or scatter both types of ultraviolet radiation. Sunscreens are rated in strength according to a sun protection factor (SPF). Those with a SPF value of 2 to 11 provide minimal protection; those with a SPF of 12 to 29 provide moderate protection, while those with an SPF of 30 or higher provide high protection against sunburn. Sunglasses that have UV-absorbing lenses should also be worn. The label should specify that the lenses block at least 99 percent of UVA and UVB radiation. ROC offer a range of screens with MINESOL(TM) that protect the skin against the negative effects of UVAs and UVBs. People with a history of melanoma would be advised to look at their SPF 60 sunblock cream. Uvistat