Invasive melanoma of the skin was reported diagnosed in 290 cases among SRRHIS residents from 1991 through 1993. Almost all of these were among white persons, as melanoma is rarely seen in blacks. The rate for white males was about 40 percent higher than the rate for white females but both were considerably lower than the Atlanta or SEER comparison groups (white males SRRHIS: 13.8; Atlanta: 22.6; SEER: 16.5; white females SRRHIS: 9.5; Atlanta: 13.4; SEER: 11.7 (Figure 16). This type of cancer may be subject to under reporting in the SRRHIS region, as cases may be diagnosed early in private physicians' offices and patients may never be hospitalized nor hospital pathology reports filed. Early stage in situ cancers may be especially under reported, since SEER rates suggest that in situ melanoma accounts for about 30 percent of the diagnoses overall (Parker, 96). For the years 1991 through 1993, in situ cancers made up less than 12 percent of the melanomas reported in the SRRHIS registry (Figure 17).

Fortunately, melanoma is a cancer that can be detected early and treated successfully, and increasing public education has accomplished such a stage shift to early disease that under reporting becomes a quality control concern. In the SRRHIS population, 62 percent of cases were diagnosed while still localized. Overall five year relative survival rates for invasive melanomas are 87 percent; the rate for persons with localized tumors is 94 percent (Kosary, 95).

The major risk factor for melanoma is sun exposure among fair skinned persons. Ultraviolet light may promote the development of malignancy in susceptible persons. Persons at high risk include those with many typical or atypical moles, those who freckle easily, those with family history of melanoma, and persons with a history of severe sunburn, especially in childhood (Miller, 93). The long-term effect of environmental ozone depletion on melanoma rates is uncertain, but is of concern for this and the more common basal and squamous cell skin cancers.

Preventive strategies for all sun related skin cancers should include avoiding midday sun when ultraviolet exposure is greatest, and using protective clothing and sunscreens to minimize sun damage.