A combined strategy of public education and early diagnosis currently offers the only hope of cure for people with melanoma, warn senior doctors in this week’s BMJ.

Melanoma is a deadly but potentially curable type of skin cancer, largely thought to be caused by excessive and intense intermittent exposure to sunlight. The incidence of melanoma is rising faster than any other cancer and is approximately doubling every decade.

Yet, surprisingly, no surgical procedure or therapy has been shown to improve overall survival.

However, there is recent encouraging evidence that a combined strategy of public education and early diagnosis may be effective, write J Meirion Thomas and Victoria Giblin.

Public health campaigns that highlight the danger of excessive sun exposure and the importance of spotting unusual skin lesions early seem to be having an effect.

Although the overall incidence of melanoma continues to rise, there is evidence that the rate of increase of in-situ melanoma is falling, they say. There is also evidence that incidence of invasive melanoma is stabilising in individuals of 35-45 years, and younger, and that the incidence of thick melanomas (greater than 3mm) has stabilised or declined in the same age groups.

Deaths from melanoma may also be falling. Data from Australia, USA and UK suggest that, in females, melanoma deaths may have reached a plateau but continue to rise in males.

In conclusion, early diagnosis of melanoma currently offers the only hope of reducing mortality and efforts must be intensified in this regard, say the authors. Primary prevention is relevant in order to stress the importance of lifestyle (avoiding the midday sun), protective clothing and sunscreens.

Above all, the risk of sunburning in childhood and adolescence should be stressed at every opportunity, they conclude.

http://press.psprings.co.uk/bmj/april/edit987.pdf