Melanoma Risk Factors, Prevention, and Treatment Overview

Introduction

The disorder has been known since antiquity. Melanoma derives its name from the Greek words melas (dark) and oma (tumor), a term first coined by Hippocrates in the 5th century BCE (Smith, 2017). Although the first successful excision of a melanoma tumor was performed in 1787, it was not until 1804 that melanoma was identified as a separate disease. The term "melanoma" was first formally applied to the condition in 1838 by the Scottish pathologist Sir Robert Carswell (Smith, 2017). Despite these early advances in identification, most studies conducted prior to the latter half of the 20th century were descriptive in nature and did not provide any indication of the disease's underlying etiology or mechanistic basis (Rebecca, Sondak & Smalley, 2012).

In recent years, less invasive surgical procedures have been developed to treat melanoma, and far more has been learned about its causes (Rebecca et al., 2012), including the concentrated ultraviolet (UV) lights used in popular tanning booths (Gershenwald, Halpern & Sondak, 2016; Konkolova, Provaznikova, Jirakova & Hercogova, 2014). Based on this track record of consistently improving success in diagnosing and treating the disease, Rebecca and associates (2012) conclude that, "We are confident that as we move forward, our rapidly evolving knowledge will allow us to bring melanoma to the level of a chronic, manageable disease and not the intractable 'black cancer' of old that struck fear into the hearts of those who observed it" (p. 122). Notwithstanding this impressive progress, however, tens of thousands of Americans still develop melanoma each year.

Statistics and Epidemiology

In 2014, approximately 1.2 million Americans were living with melanoma of the skin in the United States (Melanoma statistics, 2018). Approximately 87,110 new cases of melanoma are diagnosed each year in the United States, representing about 5.2% of all new cancer cases (Melanoma statistics, 2018). About 9,370 people die each year as a result of melanoma, representing around 1.6% of all cancer deaths, at a rate of approximately 22.3 new cases and deaths per 100,000 men and women per year (Melanoma statistics, 2018). Moreover, despite improvements in early diagnosis and the development of more efficacious interventions, there has been a slow but insidiously steady increase in the prevalence of melanoma over the past 25 years in the United States.

The lifetime risk of developing melanoma is approximately the same for both men and women; about 2.2% of each sex will be diagnosed with melanoma of the skin during their lifetime (Melanoma statistics, 2018). Five-year survival rates for both sexes and all races are comparable and depend significantly on the stage at diagnosis (Melanoma statistics, 2018).

Although the precise causes of melanoma remain under investigation, both genetics and environmental conditions have been implicated. Among the risk factors for melanoma identified to date are the following:

• Fair skin (it is important to note that people with darker skin, including Hispanics and Black individuals, can also develop melanoma);
• A history of sunburn;
• Excessive UV light exposure (e.g., tanning booths, living at higher elevations or closer to the equator);
• Having many moles or unusual moles;
• A family history of melanoma; and
• A weakened immune system (Risk factors for melanoma, 2018).

Financial Costs of Melanoma Treatment

Based on their analysis of melanoma treatment costs from 1990 through 2011, Guy, Ekwueme, and Tangka (2015) calculated the overall per-patient costs of melanoma as well as costs by phase of care, stage of diagnosis, and the health care setting and type of care received. The annual overall costs for treating all stages of melanoma were estimated at between $44.9 million for Medicare patients with existing cases to nearly one billion dollars ($932.5 million) for newly diagnosed cases across all age groups (Guy et al., 2015).

These overall costs include direct medical care expenses, but the costs to American society also encompass lost productivity and financial burdens on families (Guy et al., 2015). These costs differed significantly depending on the stage at diagnosis and the treatment setting, with outpatient treatments for later-stage diagnoses costing considerably more (Guy et al., 2015). Based on their findings, Guy and associates (2015) conclude that, "It is clear that melanoma treatment presents a substantial economic burden, particularly among late-stage diagnoses and during the terminal phase of care" (p. 544).

Conclusion

First identified in antiquity, melanoma has been the focus of a growing body of research due in large part to its continuing increases among the American population in general and among tanning booth and sun-bathing enthusiasts of all ages and races in particular. Although the research shows that people with fair skin are at higher risk of developing melanoma, the disease affects men and women of all ages and races. One of the more perplexing findings to emerge from the research is the fact that the risk of excessive exposure to ultraviolet light has been consistently identified as a preventable risk factor for melanoma, yet tens of thousands of consumers continue to develop the disease from these largely avoidable causes.

In the final analysis, it is reasonable to conclude that greater efforts at public education are needed to raise awareness of the dangers of excessive exposure to ultraviolet light, while the search for a precise cause and more efficacious treatments continues. Although women are at slightly higher early risk for melanoma, studies have found that women demonstrate higher engagement in proactive health measures to combat the cancer and ultimately maintain better long-term outcomes with lower rates of recurrence. More research is needed to accurately diagnose the root causes of melanoma and to develop more effective prevention strategies.

References

Diagnosing and treating melanoma. (2018). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/melanoma/diagnosis-treatment/drc-20374888.

Gershenwald, J. E., Halpern, A. C., & Sondak, V. K. (2016). Melanoma prevention — avoiding indoor tanning and minimizing overexposure to the sun. JAMA: Journal of the American Medical Association, 316(18), 1913–1914. doi:10.1001/jama.2016.16430

Guy, G. P., Ekwueme, D. U., Tangka, F. K., & Richardson, L. C. (2012). Melanoma treatment costs: A systematic review of the literature, 1990–2011. American Journal of Preventive Medicine, 43(5), 537–545.

Hood, E. (2009, June). Why males are more at risk for melanoma. Environmental Health Perspectives, 112(8), 466–468.

Khosrotehrani, K., Dasgupta, P., Byrom, L., Youlden, D., Baade, P., & Green, A. (2015). Melanoma survival is superior in females across all tumor stages but is influenced by age. Archives of Dermatological Research, 307(8), 731–740. doi:10.1007/s00403-015-1585-8

Koh, H. K., Sinks, T. H., & Geller, A. C. (1999). Etiology of melanoma. Cancer Treatment and Research, 65(1), 28.

Konkolova, R., Provaznikova, D. H., Jirakova, A., & Hercogova, J. (2014). Can melanoma therapy change attitudes toward prevention and tanning? Dermatologic Therapy, 27(3), 156–158. doi:10.1111/dth.12100.

Melanoma statistics. (2018). National Cancer Institute. Retrieved from

Rebecca, V. W., Sondak, V. K., & Smalley, S. M. (2012, April). A brief history of melanoma. Melanoma Research, 22(2), 114–122. doi:10.1097/CMR.0b013e328351fa4d

Risk factors for melanoma. (2018). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/melanoma/symptoms-causes/syc-20374884

Smith, Y. (2017). Melanoma history. Medical and Life Sciences News. Retrieved from