Screenings Called Success in Detection of Melanoma

This year, about 500,000 Americans will develop skin cancer. Most will have a highly curable form, but 27,000 people will be diagnosed with a potentially deadly type known as melanoma.

For melanoma sufferers, doctors say the best hope for long-term survival is early diagnosis. A new study suggests that a free nationwide screening program begun in 1975 can be highly effective in detecting melanoma and other skin cancers at an early stage.

The study marked the first comprehensive follow-up of people who were thought to have skin abnormalities when doctors examined them visually. They were told to go to their physicians or dermatologists for further diagnoses.

Researchers at Boston University’s schools of medicine and public health tracked down 289 people out of 787 in Massachusetts who had seemingly abnormal screens when they were examined at 14 locations around the state in 1986 and 1987. Another 1,773 people screened at the same time had normal results.

Dr. Howard Koh, who led the study, said that among these 289, there were nine confirmed cases of melanoma and 133 other types of skin cancers. To Koh, the figures indicate the screening program is successfully attracting people who are at greatest risk of developing skin cancer.

In the general population, the melanoma rate is one in 10,000. But among those in Koh’s study, the rate was nearly one in 300.

“This implies to us that the right people--those at high risk--are coming out to take advantage of the screenings,” said Koh, an associate professor at the university.

He said it also suggests that the skin screenings, which are held each spring at scores of locations around United States, might someday prove as effective in detecting early skin cancer as Pap smear tests for cervical cancer or mammography for breast cancer.

“Although the screening program is not new, there had been very little effort to find out what happened to people after they were examined,” Koh said. “We were very encouraged by what we found.”

The screenings, usually held in May and June, are sponsored by the American Academy of Dermatology. The results of Koh’s study appeared in the journal Cancer.

Koh said the incidence of melanoma in the United States has reached “epidemic proportions” in recent years for reasons that are not fully understood. The National Cancer Institute says that between 1973 and 1986, the melanoma rate increased 93% among men and 59% among women.

The chief factors that predispose people to melanoma and other skin cancers are thought to be skin type and degree of exposure to sunlight, said Dr. Gary Rogers, who is co-director with Koh of a new skin cancer center at University Hospital in Boston.

Those at highest risk have “fair skin, freckling, blue eyes and a family history of skin cancer,” Rogers said. People of Celtic-Irish background appear to have a higher risk than equally fair-skinned people with German or Scandinavian roots.

Rogers said another apparent risk factor appears to involve the duration and intensity of a person’s exposure to the sun during teen-age and early adult years.

“It seems that receiving blistering blasts of sun during the years 12 to 25 increases the skin cancer risk,” Rogers said.

The most common and curable forms of skin cancer--such as the type Former President Ronald Reagan experienced--are almost never life-threatening but can be disfiguring unless diagnosed early.