Prevention and early detection of melanoma: a surgeon's perspective

Americans are clearly losing the battle against malignant melanoma. In 1930, it was estimated that one in 1,500 people would develop melanoma sometime during their lifetimes, but by the year 2000, one in 75 people in the United States will develop the disease. Although the individual case prognosis is improving, the death rate has doubled in the last 35 years. The rising mortality rate has to be attributed to an escalating incidence that is not offset sufficiently by improved diagnosis and treatment. Malignant melanoma is a disease that lends itself to early detection and screening programs. Melanoma is highly prevalent and causes considerable morbidity and mortality. The natural history of the disease is known and it is well established that the earlier diagnosis of "thinner" lesions can reduce morbidity and mortality. There is also an acceptable, safe, inexpensive, and noninvasive screening test for melanoma, the skin examination. This work reviews the current evidence that melanoma screening may be effective, compares screening projects for this cutaneous tumor with other screening programs, and outlines a proposed project for melanoma screening.