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Action Plan logo
Executive Summary
Background Paper
  I. Incidence, mortality, and impact on society
  II. Skin cancer
  III. Contributing and causative factors
  IV. Prevention
  V. Cancer prevention and information services that impact the skin cancer problem
  VI. Barriers to early detection and treatment of skin cancer in Texas
  VII. Policy initiatives that would affect skin cancer awareness and prevention
  VIII. Professional practice regarding skin cancer prevention, detection, and treatment
  IX. Prevention and information models
Action Plan
  Goal I Initiate data collection and analysis
Goal II Develop prevention information and services to increase public awareness
Goal III Enhance professional education and practice
Goal IV Improve access to prevention, detection, and treatment
  i. Melanoma of the Skin Incidence and Mortality Rates, 1988-1992
ii. Five-Year Relative Survival Rates, by Site 1986-1992
iii. Average Years of Live Lost per Person Dying of Cancer, 1993
iv. Demographic Characteristics of Patients Diagnosed with Malignant Melanoma of the Skin
v. Counties Reporting Health Care Availability as an Issue
vi. Federally Designated Medically Underserved Areas
vii. Additional Texas Cancer Council Initiatives

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  Background Paper title
Skin cancer is the most prevalent cancer in the United States today; it is also the most preventable. Texas ranks third in the nation for incidence of malignant melanoma, the most deadly of all skin cancers, suggesting the urgent need for an examination of the problems of prevention, detection, and treatment of skin cancer in Texas. The Texas Cancer Council's Action Plan on Skin Cancer for the State of Texas identifies current skin cancer education, prevention, detection, and treatment resources. It recommends approaches and resources that need to be developed to thoroughly evaluate and reduce the incidence of skin cancer in the state, so that the trend of steadily increasing morbidity and mortality associated with skin cancer in Texas may be reduced.

Incidence, mortality, and impact on society

A . Incidence and mortality nationwide
Half of all new cancers in the United States are skin cancers, and about 1.3 million new cases of skin cancer will be diagnosed in the coming year. [ 1 ] One in five individuals in this country will develop skin cancer in his or her lifetime. [ 2 ] The incidence is even higher in the Sunbelt states, including Texas, where the lifetime risk of developing skin cancer is one in three . [ 3 ]

The three most prevalent types of skin cancer in the United States today are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (MM). Within this group, BCC accounts for 80%, SCC represents 16%, and the remaining 4% are MM. The nationwide incidence of MM tripled between 1980 and 2000. [ 4 ] Caucasians have the highest age-adjusted incidence and mortality rates for melanoma, followed by Hispanics, and then African-Americans. (Appendix i) Of these three groups, African-Americans have the lowest survival rate. (Appendix ii ) [ 5 ]

A recent analysis of Surveillance, Epidemiology, and End Results (SEER) statistics reports that incidence of MM is increasing at a rate of 2.8% a year even as the incidence of most other cancers is declining. [ 6 ] (See graph below)

Annual Percentage Change (APC) in Cancer Incidence Rates
Top ten sites by gender, all ages, all races, 1990-1997

Annual Percentage Change in Cancer Incidence Rates 1990-1997

Incidence data are from 11 Surveillance, Epidemiology, and End Results (SEER) program areas covering 14% of U.S. population.
Rates are per 100,000 persons and age-adjusted to the 1970 U.S. standard million population.

# APC is based on gender-specific rates; NOS: not otherwise specified.
* The APC is statistically significantly diff e rent from zero (2-sided P<0.05).

Source: Reis, Lynn A.G., et al (2000) The Annual Report to the Nation on the Status of Cancer, 1973-1997. Cancer. (88) 10, 2398-2424.


The American Cancer Society (ACS) projects that in 2000 there will be 47,700 new MM cases in the United States. Unless diagnosed and appropriately treated early, MM invades other parts of the body, and this metastatic involvement is responsible for the high mortality rate. MM accounts for 79% of skin cancer deaths; the ACS currently estimates that the nation will experience 7,700 deaths from melanoma this year, [ 1 ] approximately 1 MM death every hour. [ 4 ]

The steady increase of MM is a predictor for the increase of BCC and SCC, since all three forms of skin cancer are related to ultraviolet radiation (UV radiation), and BCC and SCC are estimated to be as much as 24 times more numerous than MM. 1

Although more prevalent, BCC and SCC are unfortunately not required to be reported to cancer registries. As a result, estimates of the prevalence of BCC and SCC rely on a variety of small-scale epidemiological surveys. These data are extrapolated to arrive at a number relevant to known physician practice patterns and patterns of recurrence of BCC and SCC, with the result that their incidence is consistently underestimated.

The general consensus among dermatologists is that the actual incidence of all three skin cancers is far higher than even the most pessimistic estimates. [ 7 ] More accurate counts of these three skin cancers would work to mobilize public opinion and support for policies that might reverse the alarming increase in the prevalence of these cancers.

B . Incidence in Texas
The ACS projects that Texas will have 3,400 new melanoma cases in 2000; this number reflects a substantial increase from the 2,900 cases that were estimated for 1999. [ 1 ] The lack of more precise incidence data for BCC and SCC limits our understanding of the full magnitude and distribution of the problem, thereby inhibiting effective strategies for developing awareness and prevention programs for these cancers in Texas. [ 8 ]

C . Impact on society
As with other forms of cancer, the impact of MM on society results from years of potential life lost and cost of treatment. Currently, these parameters are determined from existing databases on this cancer. Since the incidence rates of BCC and SCC are estimated to be much higher, the toll of time lost from work, and disability due to disfigurement resulting from these cancers is also significant.

  1 . Years of productive life lost
The National Cancer Institute estimates that the average years of productive life lost (PLL) for persons dying from melanoma is 19.8 years. (Appendix iii) [ 9 ] This number reflects an increase of more than 2 1 /2 years of PLL since the previous estimate less than 5 years earlier. These figures are based on the fact that MM is occurring in an ever-younger population. A recent National Cancer Data Base analysis of the demographic characteristics of individuals diagnosed with MM found that that 21% were under 40 years old, and an additional 17% were between 40 and 49 years old. (Appendix iv) [ 8 ] It is clear that the years of productive life lost due to MM are significant.
2 . Economic toll
A 1997 study estimated that the total annual cost of treating newly diagnosed MM in the United States was $563 million. The major portion of this cost was attributed to the treatment of advanced disease. The study concluded that, "aggressive primary prevention through sun protection and intensive screening to enhance earlier detection should reduce the economic burden of melanoma care." [ 11 ]

1 Based on the percentage breakdown within the classification of the three most prevalent types of skin cancer: 80% basal cell carcinoma (BCC), 16% squamous cell carcinoma (SCC), and 4% malignant melanoma (MM). (American Academy of Dermatology, 2000)
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