What are the demographic characteristics of malignant melanoma?

Demographic Characteristics of Malignant Melanoma

Malignant melanoma predominantly affects fair-skinned populations, with a lifetime risk of 1 in 34 for women and 1 in 53 for men, and a median age at diagnosis of 59 years. 1

Incidence and Mortality

• Melanoma incidence continues to increase dramatically in developed countries:

  • Increasing more rapidly in men than any other malignancy
  • In women, increasing more rapidly than any other malignancy except lung cancer 1
  • Rising over 320% in the US since 1975 2

• Mortality impact:

  • Average loss of 20.4 years of potential life per melanoma death (compared to 16.6 years for all malignancies) 1
  • Ranks second to adult leukemia in terms of loss of years of potential life per death 1
  • US mortality has fallen almost 30% over the past decade with newer therapies 2

Distribution by Stage at Diagnosis

• 82-85% of patients present with localized disease
• 9-13% present with regional disease
• 2-5% present with distant metastatic disease 1

Racial and Ethnic Distribution

• Significant racial disparities exist:
  • Incidence among whites is 20 times higher than among blacks
  • Incidence among whites is approximately 4 times higher than among Hispanics 1
  • Most common in white, older men, with average age of diagnosis of 65 2

Gender Differences

• Recent trends show:
  • Continuing upward trends in older age groups, particularly among men (7.20% increase per year in men aged 75+)
  • Stabilizing incidence for younger men
  • Declining incidence for younger women (-3.03% annual change for women aged 15-34) 3
  • Men older than 65 account for 22% of newly diagnosed cases annually
  • Women older than 65 account for 14% of newly diagnosed cases 1

Survival Rates

• Overall 5-year survival has risen to 93.3% in the US 2
• Prognosis by stage:
  • Localized disease with tumors ≤1.0 mm: >90% 5-year survival
  • Localized melanomas >1.0 mm: 50-90% 5-year survival (depending on tumor thickness, ulceration, and mitotic rate)
  • Regional node involvement: survival rates roughly halved
  • Stage III: 5-year survival rates range from 20-70% (depending on nodal tumor burden)
  • Stage IV (metastatic): 29.8% 5-year survival 1, 2

Risk Factors

• Major risk factors include:

  • Skin type (fair skin that burns easily and tans poorly)
  • Personal history of prior melanoma
  • Multiple clinically atypical moles or dysplastic nevi
  • Positive family history of melanoma
  • Inherited genetic mutations (rare)
  • UV exposure (especially intermittent or intense exposure) 1

• Environmental factors:

  • Outdoor UV exposure without protection is the main risk factor
  • Intermittent or intense sun exposure appears to be a greater risk factor than chronic exposure
  • Indoor tanning beds may contribute to risk 1, 2

Geographic Variations

• Considerable variation in patterns of melanoma incidence and mortality exists within Europe 4
• Australia has implemented primary prevention initiatives since 1988, with melanoma incidence peaking in 2005
• US melanoma incidence is not projected to peak until 2022-2026 2

Clinical Implications

• Early detection is crucial for improving outcomes, especially in regions with poorer survival rates
• Prevention strategies should focus on UV protection, particularly in children and youth
• High-risk individuals require careful surveillance and consideration for genetic counseling
• Less than 40% of Americans report practicing adequate sun protection 2