ABSTRACT
Melanoma incidence and mortality have risen dramatically during this century in
almost all countries and, in particular, in fair-skinned populations (1,2). In the
United States, in 1935, one’s estimated lifetime risk of disease was one in
1500 (3). In the year 2000, the lifetime risk of melanoma was estimated at 1 in
75 persons. In Australia, the lifetime risk has been estimated at 1 in 25 (3).
Some have questioned whether these statistics truly reveal an alarming increase
in disease or, in fact, are a sign of increased efforts at screening and diagnosing
the disease (4,5). Others do not hold this view (6). Some have suggested much of
the increase has been in a non-metastasizing biologically benign form of mela-
noma or simply in changes in the diagnostic criteria for melanoma by pathol-
ogists (4,5). The implications of this debate on public health initiatives are
substantial. In many countries, worldwide melanoma is of significant concern
and in these countries public interventions are being conducted to promote
earlier detection and treatment of the disease. Are these efforts worthwhile or
would resources be better spent elsewhere? The answer depends not only on
the interventions themselves, but also on the true nature of the epidemic. The
most recent data on melanoma incidence suggests that while melanoma is
being diagnosed earlier accounting for much of the increase in incidence, the
percent increase of localized tumors of all Breslow levels have increased since
the late 1980s (7-9). Moreover, mortality has been increasing at rates that
warrant concern (7), and higher mortality rates suggest that the increased inci-
dence is not due to screening alone.
