Midwestern States Witness Significant Increase in Melanoma Deaths Over a Decade

Melanoma continues to be the deadliest type of skin cancer in the United States, responsible for an average of 9000 deaths each year, according to the CDC—however, there is a definite state-level gradation observed with both incidence and death from the disease. According to an analysis published in JAMA Dermatology,¹ 23 of 48 (48%) states in the United States saw a drop in melanoma-associated deaths in 2013 compared with 2003, as opposed to 21 states (44%) that witnessed a rise. Four states (8%) saw no change in their melanoma death rate between 2003 and 2013.

A definite regional trend is apparent from the available data, as seen in the following table.

Region

Decrease in Death

Increase in Death

No Change in Death

Northeastern states

6/9 (67%)

2/9 (22%)

1/9 (11%)

Midwestern states

1/11 (9%)

10/11 (91%)

0/11 (0%)

Southern states

7/16 (44%)

7/16 (44%)

2/16 (13%)

Western states

9/12 (75%)

3/12 (25%)

0/12 (0%)

*No data available for Alaska and North Dakota

As for the incidence of melanoma, 11 of 49 states (22%) saw a decrease and 38 (78%) saw an increase in incidence. The following regional trend was documented:

• Northeastern states: decrease in incidence in 5 states (56%) and an increase in 4 (44%)
• Midwestern states: decrease in incidence in 2 states (17%) and an increase in 10 (83%)
• Southern states: decrease in incidence in 1 state (6%) and an increase in 15 (94%)
• Western states: decrease in incidence in 3 states (25%) and an increase in 9 (75%)

More than 90% of melanoma is associated with damage caused by ultraviolet radiation. Community-based preventive efforts such as providing more shade on playgrounds, pools, and other public spaces where there is an increased risk of exposure to sunlight are important. Additionally, the CDC recommends using various channels, such as employers, childcare centers, schools, and colleges, to raise public awareness on protecting the skin from ultraviolet rays.

A systematic review of direct medical costs associated with melanoma treatment found that the annual treatment costs range from $44.9 million among Medicare patients to $932.5 million among newly diagnosed patients across all age groups. A point to note is that the study² used data published between January 1990 and December 2011, which was prior to the approval of immuno-oncology agents like nivolumab and pembrolizumab, which cost more than a $100,000 individually. As these agents find wider acceptance in the community, the associated medical spend is expected to skyrocket.

Prevention programs might hold significant value, the authors of the JAMA study wrote. They cite the example of the Melanoma Foundation of New England, founded in 1999, which became very active during the study period. A recent initiative by the foundation has made sunscreen dispensers available in public and recreational areas throughout Boston—such efforts, the authors wrote, can suppress the incidence of melanoma.

References

1. Mounessa JS, Caravaglio JV, Dellavalle RP. Comparison of regional and state differences in melanoma rates in the United States: 2003 vs 2013 [published online December 28, 2016]. JAMA Dermatol. doi:10.1001/jamadermatol.2016.4625.
2. Guy GP, Ekwueme DU, Tangka FK, Richardson LC. Melanoma treatment costs: a systematic review of the literature, 1990—2011. Am J Prev Med. 2012;43(5):537-545. doi: 10.1016/j.amepre.2012.07.031.