Clinical Review

Melanoma—Part 1: epidemiology, risk factors, and prevention

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a2249 (Published 20 November 2008) Cite this as: BMJ 2008;337:a2249
  1. Veronique Bataille, consultant dermatologist1, senior research fellow 2,
  2. Esther de Vries, senior cancer epidemiologist3, epidemiology consultant 43
  1. 1West Hertfordshire Hospitals NHS Trust, Hemel Hempstead HP2 4AD
  2. 2Twin Research and Genetic Epidemiology Unit, King’s College London SE1 7EH
  3. 3Department of Public Health, Erasmus MC University, Medical Center, Rotterdam, Netherlands
  4. 4Department of Dermatology, Erasmus MC University Medical Center, Rotterdam
  1. Correspondence to: V Bataille bataille{at}doctors.org.uk

    Summary points

    • The incidence of melanoma is rising, but most of the rise is caused by very thin melanomas

    • The most powerful risk factor for melanoma is the number of naevi

    • There are two phenotypic pathways to melanoma: via naevi or via sun damage

    • Melanoma mortality has been relatively stable over the past 30 years

    • A reduction in people’s exposure to sun has not led to a significant reduction in the incidence of melanoma, and sun avoidance may be detrimental; secondary prevention with early detection of melanoma saves lives

    The incidence of melanoma has risen over the past 30 years in most white populations.1 2 However, in some parts of the world incidence rates are stable or falling. Although large scale primary prevention programmes such as public health education campaigns aimed at reducing exposure to sun may lead to reduced incidence, such programmes have not yet been proved effective. However, melanoma is highly amenable to secondary prevention through early detection. Being able to recognise a melanoma early is an important skill for primary healthcare practitioners. In this first article of a two part series on melanoma, we examine the evidence on the genetic epidemiology of melanoma and outline the complex interactions between incidence, mortality, and survival trends; we also discuss the evidence for prevention.

    How common is melanoma?

    Although melanoma remains a relatively rare tumour, many European countries show an annual increase in incidence above 2%; in some northern European countries, however, no significant increase has been observed.1 Between 1992 and 2005, the annual increase in incidence rates of melanoma in the United States was 2.3% for all races and 2.8% in white populations.3 Queensland in Australia had an increase in incidence of 1.4% for males and 0.7% for females during 1982 to 2001.4 Most recent incidence data show that in some …

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