Primary strategy of early detection seen as best hope for melanoma

MIAMI BEACH, Fla. — Primary prevention strategies have been unable to slow the growth of melanoma, but secondary prevention could work in the near future, according to a presentation today at the American Academy of Dermatology annual meeting.

Martin A. Weinstock, MD, PhD, professor of dermatology and epidemiology at Brown University, focused on reducing UV exposure as the primary prevention strategy. He defined secondary prevention as early detection and excision of lesions before they become potentially fatal melanomas.

A problem with primary prevention is that even if physicians could control the amount of UV exposure that patients receive, there is a large gap of time between exposure time and the appearance of melanoma, Weinstock said.

“It would be possibly decades before we saw and impact on society,” he said. Primary prevention “takes a long time.”

“We have these great sunscreens now,” Weinstock added. “… but we also have this other source of UV, which is also more commonly used than it used to be, and that’s indoor tanning.”

Weinstock went to a recent national survey data and picked out high school seniors, who were asked if they usually or always use sunscreens with an SPF of 15 or higher. Boys were less likely than girls to use sunscreen (6% vs. 16%). The study also asked the students if they had been to a tanning booth in the past year, with 9% of boys and 32% of girls saying they had tanned indoors. “Both boys and girls had a lot more use of indoor tanning than the consistent use of sunscreen,” Weinstock said.

“This is why one might suspect that we are taking more steps back than taking steps forward in terms of primary prevention of melanoma, at least at this point and time,” Weinstock said.

Population-based incidence of invasive melanoma has been going steadily up for the past 25 years, Weinstock said. And, in men and women under the age of 40 years, men have been relatively flat in their incidence of melanoma, whereas women’s incidence of melanoma has been going up.

Studies demonstrate that “a large proportion of melanomas can be attributed to indoor tanning among people who have been exposed to indoor tanning.”

So, “primary prevention is not working at this point,” Weinstock said.

Secondary prevention has the potential to save many lives, he said. And, it could possibly produce results within a decade.

“We do have some case control evidence that skin self-examination can be effective in reducing mortality from melanoma … [and] that clinician skin examination can be effective in reducing mortality from melanoma.”

Weinstock used two time series as examples of successful secondary prevention. One focused on a large employer in California, which after noticing many melanomas among its employees for decades, started a formal screening program of skin exams by a dermatologist and instructions for skin self exams for detection of melanoma.

“You have this progressive intervention here,” Weinstock said. “With awareness and screening there were fewer melanomas per thousand population of those employees who were diagnosed at that point of time,” Weinstock said.

He also mentioned a study in the German state of Schleswig-Holstein, where the melanoma mortality rate dropped by 48% over a decade following a screening intervention program.

“Early detection can work,” Weinstock concluded.

Disclosure: Dr. Weinstock served as a consultant for Merck & Co. Inc.

For more information:

Weinstock MA. S040 – Cutaneous Oncology. Presented at: American Academy of Dermatology 2013 Annual Meeting; March 1-5, Miami Beach, Fla.