Increasing Rates of Melanoma and What to Look For

Melanoma rates are on the rise across the US, according to David Goldberg, MD, JD, medical director of Skin Laser and Surgery Specialists of New York and New Jersey; director of cosmetic dermatology and clinical research at Schweiger Dermatology Group in New York, New York; conference chair of South Beach Symposium (SBS) 2023, and a Dermatology Times® Editorial Advisory Board member. Goldberg discusses the increased rates of melanoma and risk factors associated with cutaneous melanoma during his session "Advances in Melanoma" at SBS 2023.

There are numerous risk factors for cutaneous melanoma, including atypical melanocytic nevi, ultraviolet (UV ) radiation, childhood and adolescent sunburns, and ultraviolet B (UVB) and ultraviolet A (UVA). UV radiation contributes to 80% of melanoma cases that develop in intermittently sun-exposed areas. Similarly, aggressive childhood and adolescent sunburn put young patients at a higher risk of developing melanoma later in life. Another dangerous risk factor of cutaneous melanoma is tanning beds. In 2009, the World Health Organization categorized tanning beds as a human carcinogen. According to Goldberg, tanning bed exposure before the age of 35 has a statistically significant association with melanoma.

Goldberg then reviewed the characteristics of primary types of melanomas: superficial spreading, nodular, lentigo, and acral.

Superficial spreading:

• More common in fair-skinned patients
• Makes up 60%-70% of all melanomas
• Typically found on the trunk of men and legs of women
• Two thirds of patients present with regression
• Tumors resemble horizonal growth

Nodular:

• More “worrisome”
• 2nd most common type of melanoma in fair-skinned patients
• Typically develops later in life; 6th decade
• Makes up 15%-30% of all melanomas
• Frequently found on the head, neck, and trunk
• More common in men

Lentigo:

• Common in elderly patients
• Occurs in chronically sun damaged skin, such as the face
• Makes up 10% of cutaneous melanomas
• Slow growing
• Can be asymmetrical with brown to black macules

Acral:

• Rare but found on the hands and feet, including nails
• Appears asymmetrical with brown to black macules and some color variation
• Cuticle involvement may need biopsied
• Makes up 2%-3% of all new melanomas

Lastly, Goldberg discussed melanoma and pregnancy. During pregnancy, hormones and growth factors stimulate melanocytes. Less than 10% of women will experience darkening of melanocytic nevi in the first 3 months. Goldberg noted that there is no demonstration of new development or worsening melanomas during pregnancy.

Reference

1. Goldberg D. Advances in melanoma. Presented at the 2023 South Beach Symposium Meeting; February 9-12, 2023; Miami Beach, FL.