Melanoma is a deadly but potentially curable disease. Its main cause, and the sole controllable factor, is excessive if intermittent exposure to sunlight, particularly in childhood and adolescence.1 2 The incidence of melanoma is rising faster than for any other cancer and is approximately doubling every decade, although survival rates are improving in developed countries (the United Kingdom, for example, has experienced a 30% improvement since the 1970s). Mortality in general increases with age, especially in men (figure).3

Numbers of deaths and age specific mortality rates by sex, malignant melanoma, United Kingdom, 2004. Reproduced with permission of Cancer Research UK (http://info.cancerresearchuk.org/cancerstats/types/melanoma/mortality/)

The cause for the difference in mortality between men and women may be related to primary tumour site. Melanomas of the back may drain to several lymph node basins; they are more common in men than women and their position makes them difficult for patients to find themselves.

Some recent evidence from Australia, which has the highest incidence in the world, shows that although the overall incidence of melanoma continues to rise, some rates are stabilising. For example, one study shows that the rate of increase of in situ melanoma is falling,4 and the incidence of …