MELANOMA of the SKIN Data Highlights Average annual (1991-95) age-adjusted incidence rates for melanoma of the skin among white males and females were 11. and 7., respectively; while among black males and females, the rates were much lower, 1.1 and.5, respectively. It is recognized from other cancer registries that whites have much higher risks compared to population groups with darker skin pigmentation and white males have higher risks than white females. There were 1,55 resident cases of malignant melanoma of the skin diagnosed in 1995 in Pennsylvania. Annual age-adjusted incidence rates for white males and white females have generally increased since 1986. Incidence rates for the United States, as published by the National Cancer Institute, also revealed increasing risks between 1973 and 1994. Average annual age-specific incidence rates for 1991-95 began rising with the age group 2-24. White males aged 4 and older consistently had the highest age-specific incidence rates for this five-year period. As observed with incidence, the average annual age-adjusted death rates for 1991-95 were much higher for whites, especially males. There were 375 deaths due to melanoma skin cancer among state residents in 1995, with 371 or 98.9 percent of these deaths occurring among whites. There were no discernible trends in the annual age-adjusted death rates for white males and females during the ten-year period of 1986-95. Almost 92 percent of cases of melanoma of the skin reported to the Pennsylvania Cancer Registry for 1995 were diagnosed during the in situ and local stages. Prevention of most melanoma deaths should be possible through primary prevention, such as decreased exposure to sunlight, and through screening so that earlier diagnoses can permit more effective treatment. FIGURE 1 Average Annual Age-Adjusted Incidence and Mortality Rates* by Sex and Race, Pennsylvania Residents, 1991-1995 Incidence Mortality Race/Sex All Cases/Deaths All Males All Females 2.2 1.1.6 1.5 1.6.5.3 3.2 3.4 6.7 7. 8.3 1.6 11. 2 4 6 8 1 12 Age-Adjusted Rate Risk Factors Excess exposure to the sun or other ultraviolet radiation sources, especially at an early age. Lack of skin pigmentation. Immediate family history of skin cancer. *per 1, 197 U.S. standard million population. Certain conditions -- dysplastic nevi and xeroderma pigmentosa. Therapeutic immunosuppression. Early Detection The American Cancer Society recommends routine examinations for changes in skin appearance. Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 92
Melanoma of the Skin: INCIDENCE TABLE 1-A NUMBER OF CASES AND AGE-ADJUSTED INCIDENCE RATES BY SEX AND RACE, BY YEAR PENNSYLVANIA RESIDENTS, 1986-1995 M A L E S F E M A L E S ALL* CASES ALL RACES* WHITE BLACK ALL RACES* WHITE BLACK YEAR NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE 1995 1,55 1. 878 12.7 825 13. 3.7 672 8.1 635 8.4 1.2 1994 1,342 8.8 77 11.2 73 11.5 2.5 572 7. 537 7.2 6.9 1993 1,139 7.5 665 9.8 642 1.2 8 1.8 474 5.7 454 6.1 5.7 1992 1,193 7.9 675 1. 649 1.4 8 1.8 518 6.3 58 6.8 3.5 1991 1,95 7.4 62 9.1 584 9.6 4.9 493 6.2 472 6.6 5.6 199 1,15 7.7 657 9.9 641 1.6 5 1.1 493 6.2 485 6.7 2.4 1989 1,132 7.7 613 9.5 65 1.1 2.5 519 6.5 57 7. 4.6 1988 1,88 7.6 595 9.4 58 9.9 4 1.1 493 6.2 482 6.7 8 1.3 1987 989 6.8 544 8.5 532 9. 4 1. 445 5.5 428 5.9 3.5 1986 1,56 7.5 569 9.1 547 9.4 6 1.3 487 6.3 47 6.7 6 1. * Includes any unknowns. NOTE: Age-adjusted rates are per 1, and are computed by the direct method using the 197 U.S. standard million population. See technical notes. FIGURE 1-A AGE-ADJUSTED INCIDENCE RATES BY SEX AND RACE PENNSYLVANIA RESIDENTS, 1986-1995 15 1 RATE PER 1, 5 1986 1987 1988 1989 199 1991 1992 1993 1994 1995 YEAR Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 93
Melanoma of the Skin: INCIDENCE TABLE 1-B AVERAGE ANNUAL AGE-SPECIFIC INCIDENCE RATES BY SEX AND RACE M A L E S F E M A L E S AGE ALL GROUP CASES ALL RACES WHITE BLACK ALL RACES WHITE BLACK Total 1.5 12.4 13.3.9 8.7 9.4.7 Under 5...1 -.1.1-5-9.. -.4.1.1-1-14.3.2.2 -.4.4-15-19.7.5.5-1. 1.1-2-24 2.1 1.5 1.6.4 2.7 2.9-25-29 3.4 2.8 3. - 3.9 4.3.4 3-34 5.4 5.1 5.4-5.8 6.2.4 35-39 8.6 7.4 7.8.5 9.8 1.6.4 4-44 9.8 1.2 1.7-9.3 9.7.5 45-49 13.2 14.7 15.4 1.5 11.7 12.5.6 5-54 15.4 18.2 19..9 12.9 13.7-55-59 17.7 22.1 23.4 4.2 13.8 14.7.8 6-64 23.5 33.2 34.3 4.6 15.3 16.2.8 65-69 27.3 4. 4.7 2.5 17.2 17.8 2.7 7-74 3.8 45.3 46. 8.1 2.3 21.1 3.2 75-79 31.9 52.1 53.4-19.3 19.6 2.8 8-84 33.8 55.5 56.7 8.5 22.3 22.2 6.3 85+ 28.5 47.3 48.9 12.7 21.2 21.6 4.9 NOTE: Rates are per 1, population (1991-1995) for each specified group. FIGURE 1-B AVERAGE ANNUAL AGE-SPECIFIC INCIDENCE RATES BY SEX AND RACE 6 4 RATE PER 1, 2 Under 5 5-9 1-14 2-24 3-34 4-44 5-54 6-64 7-74 8-84 15-19 25-29 35-39 45-49 55-59 65-69 75-79 AGE GROUP 85+ Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 94
Melanoma of the Skin: INCIDENCE TABLE 1-C TOTAL NUMBER OF CASES BY AGE, SEX AND RACE M A L E S F E M A L E S AGE ALL* GROUP CASES ALL RACES* WHITE BLACK ALL RACES* WHITE BLACK Total 6,319 3,59 3,43 25 2,729 2,66 2 Under 5 2 1 1 1 1 5-9 2 1 1 1 1 1-14 12 4 4 8 7 15-19 3 1 9 2 19 2-24 87 31 3 1 56 52 25-29 143 59 56 84 8 1 3-34 256 118 112 138 131 1 35-39 44 171 163 1 233 224 1 4-44 427 22 28 27 193 1 45-49 488 265 252 2 223 213 1 5-54 474 269 257 1 25 196 55-59 49 289 281 4 21 194 1 6-64 658 428 49 4 23 223 1 65-69 768 498 472 2 27 259 3 7-74 76 469 446 5 291 281 3 75-79 61 384 37 226 215 2 8-84 419 238 229 2 181 169 3 85+ 289 135 131 2 154 148 2 * Includes any unknowns. FIGURE 1-C STAGE OF DISEASE AT DIAGNOSIS, PERCENT BY SEX AND RACE PENNSYLVANIA RESIDENTS, 1995 12 In Situ 1 1. 1. Local Regional Distant 8 7.7 7.7 PERCENT 6 4 2 2.6 21. 5.3 4.8 3.4 3.5 NUMBER AND PERCENT OF CASES MICROSCOPICALLY CONFIRMED: 1,53-98.7% Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 95
Melanoma of the Skin: MORTALITY TABLE 1-D NUMBER OF DEATHS AND AGE-ADJUSTED DEATH RATES BY SEX AND RACE, BY YEAR PENNSYLVANIA RESIDENTS, 1986-1995 M A L E S F E M A L E S ALL* DEATHS ALL RACES* WHITE BLACK ALL RACES* WHITE BLACK YEAR NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE 1995 375 2.3 241 3.5 239 3.7 2.4 134 1.4 132 1.5 2.2 1994 352 2.2 217 3.2 214 3.4 3.7 135 1.4 133 1.5 2.2 1993 366 2.3 219 3.2 217 3.4 2.5 147 1.7 144 1.8 3.4 1992 377 2.3 232 3.4 229 3.6 3.7 145 1.6 141 1.7 4.6 1991 32 2. 185 2.7 182 2.9 3.7 135 1.5 134 1.7 1.1 199 362 2.3 218 3.3 213 3.5 5 1.2 144 1.6 143 1.7 1.2 1989 35 2.3 214 3.4 213 3.6 1.3 136 1.5 133 1.6 3.5 1988 316 2.1 185 2.9 183 3.1 2.4 131 1.5 13 1.7 1.1 1987 335 2.3 26 3.3 22 3.5 4.9 129 1.5 124 1.6 5.8 1986 319 2.2 189 3. 187 3.2 2.5 13 1.6 126 1.7 3.5 * Includes any unknowns. NOTE: Age-adjusted rates are per 1, and are computed by the direct method using the 197 U.S. standard million population. See technical notes. FIGURE 1-D AGE-ADJUSTED DEATH RATES BY SEX AND RACE PENNSYLVANIA RESIDENTS, 1986-1995 4 3 RATE PER 1, 2 1 1986 1987 1988 1989 199 1991 1992 1993 1994 1995 YEAR Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 96
Melanoma of the Skin: MORTALITY TABLE 1-E NUMBER OF DEATHS AND AVERAGE ANNUAL AGE-SPECIFIC DEATH RATES BY SEX AND RACE M A L E S F E M A L E S ALL* AGE DEATHS ALL RACES* WHITE BLACK ALL RACES* WHITE BLACK GROUP NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE TOTAL* 1,79 3. 1,94 3.8 1,81 4.2 13.5 696 2.2 684 2.5 12.4 UNDER 5 - - - - - - - 5-9 - - - - - - - 1-14 - - - - - - - 15-19 2. 1. 1.1-1. 1.1-2-24 3.1 1. 1.1-2.1 2.1-25-29 23.5 13.6 13.7-1.5 1.5-3-34 47 1. 26 1.1 26 1.3-21.9 21 1. - 35-39 75 1.6 46 2. 46 2.2-29 1.2 29 1.4-4-44 84 1.9 49 2.3 49 2.5-35 1.6 35 1.8-45-49 113 3.1 72 4. 71 4.3 1.7 41 2.2 41 2.4-5-54 141 4.6 98 6.6 98 7.3-43 2.7 43 3. - 55-59 128 4.6 79 6. 79 6.6-49 3.4 49 3.7-6-64 175 6.3 114 8.8 111 9.3 3 3.4 61 4. 58 4.2 3 2.5 65-69 227 8.1 145 11.6 142 12.2 3 3.7 82 5.2 79 5.4 3 2.7 7-74 241 9.8 156 15.1 154 15.9 2 3.2 85 5.9 85 6.4-75-79 23 12. 139 18.9 137 19.8 2 4.8 91 7.8 89 8.1 2 2.8 8-84 148 11.9 82 19.1 82 2.3-66 8.1 66 8.7-85+ 153 15.1 73 25.6 71 26.5 2 12.7 8 11. 76 11.1 4 9.9 * Includes any unknowns. NOTE: Rates are per 1, population (1991-1995) for each specified group. FIGURE 1-E AVERAGE ANNUAL AGE-SPECIFIC DEATH RATES BY SEX AND RACE 3 2 RATE PER 1, 1 UNDER 5 5-9 1-14 15-19 2-24 25-29 3-34 4-44 5-54 35-39 45-49 AGE GROUP 55-59 6-64 65-69 7-74 75-79 8-84 85+ Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 97
Melanoma of the Skin: INCIDENCE TABLE 1-F TOTAL NUMBER OF CASES AND AVERAGE ANNUAL AGE-ADJUSTED INCIDENCE RATES* BY COUNTY AND SEX M A L E S F E M A L E S M A L E S F E M A L E S TOTAL TOTAL COUNTY CASES NO. RATE NO. RATE COUNTY CASES NO. RATE NO. RATE ALL COUNTIES 6,319 3,59 1.6 2,729 6.7 ADAMS 4 25 11.5 15 5.9 JUNIATA 17 8 12.6 9 13.8 ALLEGHENY 523 299 7.5 224 4.8 LACKAWANNA 128 66 1. 62 7.3 ARMSTRONG 47 31 13.5 16 5.2 LANCASTER 164 94 8.1 7 5. BEAVER 11 67 11.8 34 5.3 LAWRENCE 37 12 4.2 25 6.6 BEDFORD 23 11 7.4 12 6.7 LEBANON 52 31 9.3 21 5. BERKS 21 116 11.6 85 6.9 LEHIGH 159 9 1.6 69 6.8 BLAIR 71 41 1.8 3 7.4 LUZERNE 143 77 7.4 66 4.9 BRADFORD 62 33 18.1 29 15.1 LYCOMING 65 33 9.9 32 8.8 BUCKS 381 227 15.5 154 8.6 MCKEAN 12 7 4.6 5 3. BUTLER 79 44 1. 35 7.1 MERCER 61 34 9.5 27 6.6 CAMBRIA 16 55 1.4 51 8.7 MIFFLIN 31 22 15.7 9 4.9 CAMERON 1-1 7.2 MONROE 39 24 8.2 15 4.7 CARBON 37 16 8.9 21 1.2 MONTGOMERY 434 23 11.6 24 8.1 CENTRE 7 48 17.5 22 6.4 MONTOUR 14 1 21.7 4 4.1 CHESTER 24 124 12.2 8 6.7 NORTHAMPTON 181 11 13.9 8 9.3 CLARION 19 11 9.9 8 6.1 NORTHUMBERLAND 84 47 15.6 37 11.5 CLEARFIELD 43 29 12.5 14 5.3 PERRY 32 22 2.6 1 7.9 CLINTON 23 14 13.2 9 8.1 PHILADELPHIA 494 251 6.4 243 4.5 COLUMBIA 63 43 24.8 2 9.2 PIKE 16 7 6.3 9 9. CRAWFORD 45 25 1.2 2 7.5 POTTER 6 2 4.8 4 6.8 CUMBERLAND 139 89 15.7 5 8.1 SCHUYLKILL 12 61 12.5 41 6.6 DAUPHIN 174 17 16.4 67 8.5 SNYDER 22 7 6.9 15 13.5 DELAWARE 358 217 14.2 141 7. SOMERSET 42 24 1.1 18 6.5 ELK 24 12 11.5 12 9.8 SULLIVAN 2-2 9.9 ERIE 15 62 8.5 43 4.7 SUSQUEHANNA 2 1 8.8 1 6.2 FAYETTE 49 22 4.8 27 5.5 TIOGA 2 11 8.6 9 7.3 FOREST 3 1 7.6 2 14.8 UNION 31 17 17.4 14 11.6 FRANKLIN 12 53 14.7 49 12.3 VENANGO 46 22 13.2 24 13.1 FULTON 12 7 17.4 5 1.9 WARREN 18 12 9.6 6 4.4 GREENE 17 13 11.3 4 3.7 WASHINGTON 13 63 1.1 4 5.1 HUNTINGDON 36 18 14.6 18 13.8 WAYNE 34 17 12.5 17 14.3 INDIANA 3 16 7.1 14 5.1 WESTMORELAND 177 14 9.2 73 5.5 JEFFERSON 26 2 14.3 6 4. WYOMING 19 14 17.9 5 5.8 YORK 3 164 16.9 136 12.5 * Age-adjusted rates are per 1, and are computed by the direct method using the 197 U.S. standard million population. See technical notes regarding reliability of rates. Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 98
Melanoma of the Skin: MORTALITY TABLE 1-G TOTAL NUMBER OF DEATHS AND AVERAGE ANNUAL AGE-ADJUSTED DEATH RATES* BY COUNTY AND SEX M A L E S F E M A L E S M A L E S F E M A L E S TOTAL TOTAL COUNTY DEATHS NO. RATE NO. RATE COUNTY DEATHS NO. RATE NO. RATE ALL COUNTIES 1,79 1,94 3.2 696 1.5 ADAMS 8 4 1.7 4 1.5 JUNIATA 3 2 3.5 1 1.2 ALLEGHENY 187 112 2.9 75 1.2 LACKAWANNA 32 19 2.9 13 1.4 ARMSTRONG 14 7 2.9 7 2.3 LANCASTER 66 36 3. 3 2.1 BEAVER 25 19 3.4 6.8 LAWRENCE 18 11 3.7 7 1.5 BEDFORD 5 2 1.4 3 2. LEBANON 21 11 3.2 1 2.1 BERKS 55 36 3.6 19 1.6 LEHIGH 53 35 3.9 18 1.7 BLAIR 11 5 1.2 6 1.1 LUZERNE 43 25 2.5 18 1.3 BRADFORD 5 4 2.2 1.2 LYCOMING 15 12 3.3 3.6 BUCKS 9 61 4.2 29 1.5 MCKEAN 5 2 1.2 3.9 BUTLER 28 21 5.1 7 1.5 MERCER 16 9 2.4 7 1.7 CAMBRIA 16 9 1.7 7.9 MIFFLIN 8 4 2.8 4 2.3 CAMERON 1-1 5.9 MONROE 17 11 3.6 6 1.6 CARBON 1 5 2.2 5 2. MONTGOMERY 137 72 3.5 65 2.4 CENTRE 13 5 2. 8 2.5 MONTOUR 5 3 6.3 2 2.5 CHESTER 68 47 4.6 21 1.7 NORTHAMPTON 35 27 3.6 8.8 CLARION 2-2.6 NORTHUMBERLAND 18 12 4.1 6 1.8 CLEARFIELD 8 3 1.4 5 2.1 PERRY 5 4 3.7 1.6 CLINTON 5 2 1.7 3 1.7 PHILADELPHIA 198 123 3.2 75 1.3 COLUMBIA 7 4 2.5 3 1.5 PIKE 4 1.8 3 2.1 CRAWFORD 11 9 3.5 2.9 POTTER 1 1 2.4 - CUMBERLAND 44 33 5.9 11 1.2 SCHUYLKILL 22 14 2.7 8 1.2 DAUPHIN 38 22 3.3 16 1.9 SNYDER 3 1 1.1 2 1.6 DELAWARE 97 57 3.7 4 1.9 SOMERSET 12 9 3.7 3.6 ELK 8 5 5.1 3 1.7 SULLIVAN 2 2 1.5 - ERIE 33 19 2.5 14 1.4 SUSQUEHANNA 7 5 4.1 2 1.2 FAYETTE 16 9 1.6 7.9 TIOGA 5 3 2.4 2 1.8 FOREST 2 1 4.4 1 7.5 UNION 3 1 1. 2 2. FRANKLIN 15 11 3.1 4.9 VENANGO 13 7 4. 6 3. FULTON 3 3 7. - WARREN 4 1.8 3 1.8 GREENE 12 7 7.5 5 3.9 WASHINGTON 36 18 2.8 18 2.1 HUNTINGDON 5 3 2.3 2 1.5 WAYNE 4 2 1.5 2 1.8 INDIANA 15 8 3.3 7 3.1 WESTMORELAND 57 38 3.2 19 1.1 JEFFERSON 5 3 1.9 2.8 WYOMING 3 3 4.3 - YORK 57 34 3.5 23 2.1 * Age-adjusted rates are per 1, and are computed by the direct method using the 197 U.S. standard million population. See technical notes regarding reliability of rates. Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 99