Cath Lab Digest

Melanoma incidence has been on the rise in Caucasians, especially women, according to a recent study published in the Journal of Investigative Dermatology. Researchers speculate that this may be due to increasing ultraviolet ray exposure.
   The authors analyzed Caucasian patients in the Surveillance, Epidemiology and End Results (SEER) Program between 1973 and 2004. Researchers calculated annual age-adjusted incidence and mortality rates of invasive cutaneous melanoma among men and women ages 15 to 39.

   Overall, the study found that the age-adjusted annual incidence of melanoma among young women increased from 5.5 per 100,000 people in 1973 to 13.9 per 100,000 in 2004. Among men, the melanoma incidence increased from 4.7 cases per 100,000 people in 1973 to 7.7 per 100,000 in 2004.
   Furthermore, the melanoma incidence among women from the 1990s onward increased both for thinner and thicker melanomas, and was greater for regional and distant tumors in comparison with localized lesions, according to the study. The study authors also found that melanoma mortality rates for men and women started declining in 1981.
   The increasing incidence of melanoma in young women parallels reported trends in exposure to ultraviolet rays, which the authors note is the primary environmental cause of melanoma. They add that sunburn incidence has increased in both genders. The authors conclude that additional studies should determine whether the increase in melanoma and non-melanoma skin cancer is due to exposure to UV rays.

Has There Been An Increase Of Lower Extremity Melanoma?

M. Joel Morse, DPM, has not seen an increase in lower extremity melanoma in his practice. However, he has heard that the increased use of open shoes such as flip-flops increases the sun exposure to the foot. Dr. Morse, the President of the American Society of Podiatric Dermatology, notes that people do not usually put sunscreen on the tops of their feet.
   Bradley Bakotic, DPM, DO, likewise has not seen the same incidence of melanoma on the distal lower extremities of women as researchers have shown recently in alternate anatomic locations.
   He attributes the discrepancy to the fact that the forms of melanoma that seem to be affecting women at an increasing rate are largely those related to sun exposure or tanning salons. Acral melanoma does not show as close of an association with these mechanisms of development, according to Dr. Bakotic, the Director of the Institute for Podiatric Pathology in Pompano Beach, Fla.
   Dr. Morse says the incidence of melanoma is reportedly 15 times higher in Caucasians than African-Americans. He says this is due mostly to UV exposure.
   In non-Caucasians, Dr. Morse says melanoma is most common in body parts (such as the palms, soles and subungual locations) that are not regularly exposed to the sun. Dr. Morse adds that several studies have noted that melanoma in acrolentiginous sites (feet and hands) is more prevalent in African-Americans followed by Asians, Hispanics and Caucasians.

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