The Good and Bad News About Melanoma

Melanoma is one of the cancers that it is contributing to the hopeful trend of declining cancer mortality rate in the U.S., but it also evidences“rampant racial inequalities” that American Cancer Society researchers say is threatening future gains against the disease.

In their oft-cited annual statistical report on cancer incidence and mortality that was published yesterday, American Cancer Society researchers highlighted melanoma as an example of a cancer that can now be treated with a “cascade of new regimens of immunotherapy and targeted therapy” that has improved the survival rates. The report, published in CA: A Cancer Journal for Clinicians, mentioned specifically the five-year survival rate for distant-stage melanoma, noting that it had doubled from 18% for patients diagnosed in 2009 to 35% in the 2014-2020.

Figures reported by Rebecca L. Siegel, M.P.H., the first and corresponding author, and her colleagues show a notable gap in the five-year survival rate among White and Black patients with melanoma. The five-year survival rate in 2014-2020 was 94% among White patients compared to just 70% among Black patients.

The immunotherapies used to treat melanoma included now well-established drugs such asKeytruda (pembrolizumab) and nivolumab (Opdivo) and newer ones such as Amtagvi (lifileucel),which uses T cells extracted from the melanoma tumor and amplifies them so they attack the tumor more effectively.

Melanoma ranks among the top 10 cancers in incidence. Siegal and her colleagues estimate that just over 2 million new cases of cancer will be diagnosed in 2025. Invasive melanoma will account for approximately 100,00 of those, or roughly 5%. The American Cancer Society researchers projected that there will be 618,120 cancers deaths in the U.S. in 2025, with melanoma accounting for 8,430 of them, or approximately 1.3%.

The cancer society publishes an annual “Cancer Facts & Figures” report for the general public at the same time as the more technical report in CA: A Clinical Journal for Clinician. The section on skin cancer in “Cancer Facts & Figures 2025” notes that skin cancer is the most commonly diagnosed cancer in the U.S., but two most common (and lees harmful) types, basal cell carcinoma and squamous cell carcinoma, are not reported to cancer registries, so a definite tally of the total number of skin cancer cases is not available. The “Facts & Figures” report says, though, that invasive melanoma accounts for just 1% of skin cancer cases; it is far less common than either basal cell or squamous cell carcinoma,

The incidence of invasive melanoma has been going up since the 1970s, according to “Facts & Figures” report, although there are some differences by age and sex. For example, the report says that the incidence in women younger than 50 has been relatively stable recently and that incidence decreased by 1% per year among men younger than 50 since the early 2000s. Deaths from melanoma have been declining since the early 1990s among women and since 2010 among men.

Excess exposure to ultraviolet radiation from sunlight or indoor tanning increases the risk of all skin cancer, according to the “Facts & Figures” report, and severe sunburns early in life have been associated with an increased risk of developing melanoma.

Warning signs of skin cancer include changes in the size, shape or color of a mole or another skin lesion. The ABCDE mnemonic can be helpful in alerting people so possible melanoma: A is asymmetry, B is border irregularity, C is for color (the pigmentation is not uniform), D is diameter (greater than six millimeters is clue that lesion might be melanoma) and E is evolution (the mole has changed appearance).