While a single, small melanoma lesion may seem innocuous, this potentially deadly skin cancer is projected to be diagnosed in over 97,000 Americans this year, highlighting the critical importance of sun safety and early detection.
Key Takeaways
- In 2023, approximately 97,610 new cases of invasive melanoma are projected to be diagnosed in the United States among adults aged 18 and older
- Melanoma accounts for about 1% of all skin cancers but causes the majority of skin cancer deaths, with 7,990 estimated deaths in the US in 2023
- The lifetime risk of developing invasive melanoma for Americans is about 2.6% for whites, 0.1% for Blacks, and 0.5% for Hispanics as of 2019 data
- Ultraviolet radiation exposure is responsible for 86.5% of melanomas in fair-skinned populations
- Individuals with 5 or more sunburns between ages 15 and 20 have a 2.4-fold increased risk of melanoma
- Having a family history of melanoma doubles the risk, with risk increasing to 8-fold if two first-degree relatives affected
- Nodular melanoma presents as rapidly growing 2mm+ nodule in 15-20% of cases
- Superficial spreading melanoma is most common subtype at 70% of cases, average size 2.5cm at diagnosis
- ABCDE rule: Asymmetry in 80%, irregular Border in 75%, varied Color in 90%, Diameter >6mm in 60%, Evolving in 70% of melanomas
- Overall 5-year survival for melanoma is 93.5% in US 2013-2019 diagnoses
- Localized melanoma 5-year survival 99.6%, regional 68.1%, distant 30.2%
- Wide excision with 1cm margin for <1mm Breslow achieves 99% local control
- Sun protection factor 30 blocks 97% UVB rays, reducing melanoma risk by 50% with daily use
- Daily sunscreen use from school age reduces melanoma risk by 50% in adulthood
- Avoiding midday sun (10am-4pm) prevents 23% of melanomas attributable to UV
Melanoma is a highly dangerous but increasingly treatable form of skin cancer.
Clinical Features and Diagnosis
- Nodular melanoma presents as rapidly growing 2mm+ nodule in 15-20% of cases
- Superficial spreading melanoma is most common subtype at 70% of cases, average size 2.5cm at diagnosis
- ABCDE rule: Asymmetry in 80%, irregular Border in 75%, varied Color in 90%, Diameter >6mm in 60%, Evolving in 70% of melanomas
- Dermoscopy improves diagnostic accuracy to 90% sensitivity vs 71% naked eye for melanoma
- Sentinel lymph node biopsy positive in 20% of intermediate thickness (1-4mm) melanomas
- Ulceration present in 25% of melanomas, worsens prognosis by 10-15% survival drop
- Acral lentiginous melanoma on palms/soles, 5-10% of cases, more common in Asians/Africans
- Lentigo maligna melanoma on sun-damaged face, 10-15% of cases, slower growth
- Clark level IV invasion in 40% of melanomas correlates with nodal metastasis
- Breslow thickness >4mm in 8% of cases at diagnosis, 5-year survival <50%
- Satellite lesions around primary tumor in 5-10% of cases indicate local spread
- Amelanotic melanoma lacks pigment in 3-7% cases, harder to diagnose
- Reflectance confocal microscopy sensitivity 90-97% for melanoma diagnosis in vivo
- 7-point checklist score >5 has 82% sensitivity, 69% specificity for melanoma
- Mucosal melanoma rare, 1.2% of cases, poor prognosis, 14% 5-year survival
- Desmoplastic melanoma 1-4% cases, head/neck, neurotropism in 40%
- In situ melanoma comprises 45% of diagnoses, horizontal growth phase only
- PET/CT detects distant mets with 84% sensitivity in stage III/IV melanoma
- LDH >2x upper normal predicts poor prognosis in metastatic melanoma
- Brain mets in 20% of stage IV melanomas at diagnosis
- Uveal melanoma 5% of melanomas, liver mets in 90%
- Nail apparatus melanoma 2-3% cases, poor prognosis if amelanotic
- TERT promoter mutations in 70-80% of cutaneous melanomas
- BRAF V600E mutation in 40-50% of cutaneous melanomas aids targeted diagnosis
- S100 protein positive in 95-100% melanomas for histopathology confirmation
- HMB-45 positive in 90% superficial melanomas, decreases with depth
Clinical Features and Diagnosis Interpretation
Despite the reassuring prevalence of the more manageable superficial spreading melanoma, these statistics collectively whisper a sobering truth: melanoma is a shapeshifting adversary where a millimeter's depth, a hidden ulcer, or a missed pigment can drastically tilt the odds between a simple excision and a fight for survival.
Epidemiology
- In 2023, approximately 97,610 new cases of invasive melanoma are projected to be diagnosed in the United States among adults aged 18 and older
- Melanoma accounts for about 1% of all skin cancers but causes the majority of skin cancer deaths, with 7,990 estimated deaths in the US in 2023
- The lifetime risk of developing invasive melanoma for Americans is about 2.6% for whites, 0.1% for Blacks, and 0.5% for Hispanics as of 2019 data
- Melanoma incidence rates have been increasing by an average of 1.1% annually from 2012 to 2021 in the US
- In 2022, there were 325,635 new cases of melanoma skin cancer diagnosed globally according to GLOBOCAN estimates
- Australia has the highest incidence rate of melanoma worldwide at 33.6 cases per 100,000 people standardized rate in 2022
- From 2015-2019, the melanoma incidence rate was 21.2 per 100,000 men and 15.6 per 100,000 women in the US
- Melanoma mortality rates decreased by 2.2% per year from 2013 to 2022 among males and 3.5% per year among females in the US
- In Europe, melanoma incidence is highest in Norway at 29.1 per 100,000 for men in 2020 data
- Globally, melanoma caused 57,043 deaths in 2020, representing 0.6% of all cancer deaths
- Among US adolescents and young adults aged 15-39, melanoma is the most common cancer for women in this group
- The age-adjusted incidence rate of melanoma in situ increased by 1.0% per year from 2005 to 2019 in the US
- In 2019, there were 104,960 cases of melanoma in situ diagnosed in the US
- Melanoma prevalence in the US is estimated at 1,067,366 survivors alive as of 2022
- Incidence of melanoma in people under 20 years old is 2.1 per 100,000 from 2016-2020 in the US
- From 1975 to 2021, melanoma incidence rates in the US increased by 122% overall
- In California, melanoma incidence is 25.2 per 100,000, higher than the national average due to sun exposure
- UK melanoma incidence rates have risen by 136% since the early 1990s
- In 2021, 16,500 new melanoma cases were diagnosed in the UK
- Melanoma is the 5th most common cancer diagnosed in the US
- Among non-Hispanic whites, melanoma incidence is 27.5 per 100,000 men and 19.7 per 100,000 women
- Global age-standardized incidence rate for melanoma is 3.2 per 100,000 in 2022
- In the US, 79,490 new invasive melanoma cases in men and 42,120 in women projected for 2024
- Melanoma death rate is 2.1 per 100,000 men and 1.2 per 100,000 women in the US 2016-2020
- Incidence peaks at age 85-89 for men at 57.5 per 100,000 in the US
- From 2012-2021, distant stage melanoma incidence stable at 1.4 per 100,000
- In 2020, 57% of global melanoma cases occurred in high HDI countries
- US melanoma 5-year relative survival for localized stage is 99.6% diagnosed 2013-2019
- Melanoma accounts for 75% of skin cancer deaths despite being only 1% of cases
- In 2022, New Zealand had 3,116 new melanoma registrations, incidence rate 50 per 100,000
Epidemiology Interpretation
While melanoma may only account for 1% of skin cancers, it punches a devastating 75% above its weight in lethality, making it the tiny but formidable assassin of the dermatological world.
Prevention and Public Health
- Sun protection factor 30 blocks 97% UVB rays, reducing melanoma risk by 50% with daily use
- Daily sunscreen use from school age reduces melanoma risk by 50% in adulthood
- Avoiding midday sun (10am-4pm) prevents 23% of melanomas attributable to UV
- UPF 50+ clothing blocks 98% UV, equivalent to SPF 50+ on skin continuously
- Wide-brimmed hats shade face by 60%, reducing UV by 50% vs baseball cap
- Sunglasses with UV400 block 99-100% UVA/UVB, preventing ocular melanoma risk
- No indoor tanning before 35 years cuts melanoma risk by 75%
- Skin self-exam monthly detects 70% melanomas early when curable
- Annual full-body skin exams by dermatologist reduce mortality 10-15%
- Public awareness campaigns reduced sunburn rates 20% in targeted areas
- Shade provision in recreation areas cuts UV exposure by 40-75%
- Vitamin D from supplements 1,000 IU daily maintains levels without UV risk
- School sun safety programs reduce student sunburns by 33%
- Tanning tax in California reduced teen tanning bed use by 74%
- Nicotinamide 500mg twice daily reduces new melanomas by 23% in high-risk
- Polypodium leucotomos extract 240mg reduces UV damage markers by 50%
- Workplace sun protection policies compliance 60% reduces sunburns 25%
- Melanoma awareness month screenings detect 80% early-stage lesions
- Banning commercial indoor tanning for minors in 21 US states cut teen use 80%
- Antioxidant creams with vitamins C/E reduce UV-induced damage 40%
- Community UV index apps increase sunscreen use by 30%
- High-risk family screening detects melanomas 0.7mm thinner average
- Slip! Slop! Slap! Seek! Slide! campaign in Australia reduced melanoma incidence 15%
- Reapplication sunscreen every 2 hours maintains 90%+ protection
- Avoiding sunbeds prevents 76,000 US melanoma cases over 30 years
- Public beaches with shade structures reduce UV exposure 42%
Prevention and Public Health Interpretation
The universe has handed us an extraordinarily clear cheat code against melanoma, proving that consistent, multi-layered sun sense—from slapping on SPF 30 and UPF 50+ clothing to seeking shade and sliding on sunglasses—dramatically halves our risk, making it starkly obvious that the majority of this deadly cancer is preventable through a series of simple, diligent actions.
Risk Factors
- Ultraviolet radiation exposure is responsible for 86.5% of melanomas in fair-skinned populations
- Individuals with 5 or more sunburns between ages 15 and 20 have a 2.4-fold increased risk of melanoma
- Having a family history of melanoma doubles the risk, with risk increasing to 8-fold if two first-degree relatives affected
- People with Fitzpatrick skin type I (always burns, never tans) have 2-3 times higher melanoma risk than type IV
- Indoor tanning before age 35 increases melanoma risk by 75%
- Number of nevi (moles) >100 increases melanoma risk by 7-fold compared to <15 nevi
- Giant congenital melanocytic nevi (>20 cm) carry 5-10% lifetime risk of transformation to melanoma
- Previous non-melanoma skin cancer increases melanoma risk by 1.5-2 times
- Immunosuppression from organ transplant increases melanoma risk 2-8 fold
- Red hair and MC1R gene variants increase melanoma risk 2-4 fold independently of skin type
- Occupational UV exposure increases risk by 1.2-1.5 for outdoor workers
- History of severe sunburn doubles melanoma risk in adults
- Atypical/dysplastic nevi increase risk 2-10 fold depending on number
- Personal history of melanoma increases second primary risk by 2-10%
- Fair skin, light hair, light eyes phenotype increases risk 2-fold
- HIV infection associated with 2.7-fold increased melanoma risk
- Xeroderma pigmentosum patients have 2,000-fold increased melanoma risk
- Cumulative sun exposure before age 20 associated with 2.7-fold risk increase
- Tanning bed use 10+ times increases risk by 34% for melanoma
- BRCA2 mutation carriers have 2.5-fold increased melanoma risk
- CDKN2A mutation confers 67% lifetime melanoma risk by age 80
- BAP1 syndrome increases melanoma risk with cutaneous, uveal, mesothelioma
- Acral lentiginous melanoma risk higher in darker skin types, 1.3 per million Asians vs 0.5 whites
- PUVA therapy for psoriasis increases melanoma risk 5.4-fold after >150 treatments
- Ionizing radiation exposure increases melanoma risk by 1.5-3 fold
- Obesity BMI>30 associated with 20-30% increased melanoma risk in men
- 65% of melanomas contain UV-induced mutations like C>T/G>A
- Average age at melanoma diagnosis is 66 years in the US
Risk Factors Interpretation
The statistics paint a stark portrait of melanoma: a disease shaped by inherited risk, accumulated sunburns, and lifestyle choices, where a childhood blistering burn can echo decades later alongside one's genetic hand and moles.
Treatment and Survival
- Overall 5-year survival for melanoma is 93.5% in US 2013-2019 diagnoses
- Localized melanoma 5-year survival 99.6%, regional 68.1%, distant 30.2%
- Wide excision with 1cm margin for <1mm Breslow achieves 99% local control
- Adjuvant pembrolizumab improves 5-year RFS to 44.2% vs 32.5% placebo in stage IIB/IIC
- Ipilimumab + nivolumab 2-year OS 52% vs 44% nivolumab alone in advanced melanoma
- BRAF/MEK inhibitors dabrafenib+trametinib 5-year OS 34% in BRAF V600 metastatic
- Complete lymph node dissection no benefit over observation post-SLNB in MSLT-I trial
- Adjuvant nivolumab RFS HR 0.56 in stage IIIB/C/IV resected melanoma
- TIL therapy lifileucel ORR 31.4% in advanced melanoma post-PD1/CTLA4
- Stereotactic radiosurgery for brain mets OS 7.7 months median in melanoma
- Neoadjuvant relatlimab+nivolumab pCR 19.2% in resectable stage III/IV
- High-dose IFN-alpha2b DFS benefit lost long-term, 2.1% absolute OS gain
- Lenvatinib + pembrolizumab ORR 48% in mucosal/acral melanoma
- 10-year survival for stage IA melanoma 98.4%, IB 96.4%, IIA 87.9%
- MSLT-II trial: CLND vs observation, 3-year MSS 86% vs 84.9%, no difference
- Tebentafusp median OS 21.7 months vs 16 months in HLA-A*02 uveal melanoma
- Adjuvant pembrolizumab DMFS HR 0.64 in stage IIB/IIC melanoma
- Vemurafenib ORR 53%, PFS 5.3 months in BRAF V600E metastatic melanoma
- Combined ipi+nivo OS at 5 years 52% vs 44% nivo, 26% ipi alone
- Reirradiation for locoregional recurrence control 70-80% rates
- Mapk pathway inhibitors resistance in 6-8 months median
- LAG-3 inhibitor relatlimab + nivo PFS HR 0.75 in untreated advanced melanoma
- 1cm vs 2cm margins no difference in 5-year survival 87% vs 86% for 1-2mm
- Isolated limb infusion response 71% CR 38% in in-transit melanoma
- T-VEC intralesional ORR 26.4% durable response rate 16% in advanced
- Overall response to first-line IO therapy 40-50% in metastatic melanoma
Treatment and Survival Interpretation
Melanoma's story is one of dramatic contrasts: catch it early and survival is almost guaranteed, but once it advances, it becomes a relentless adversary where cutting-edge immunotherapies and targeted treatments are slowly turning the tide, though victories are often hard-won and temporary.
Sources & References
- Reference 1CANCERcancer.orgVisit source
- Reference 2CDCcdc.govVisit source
- Reference 3SEERseer.cancer.govVisit source
- Reference 4GCOgco.iarc.who.intVisit source
- Reference 5EUROeuro.who.intVisit source
- Reference 6ACSJOURNALSacsjournals.onlinelibrary.wiley.comVisit source
- Reference 7PUBMEDpubmed.ncbi.nlm.nih.govVisit source
- Reference 8CDPHcdph.ca.govVisit source
- Reference 9CANCERRESEARCHUKcancerresearchuk.orgVisit source
- Reference 10SKINCANCERskincancer.orgVisit source
- Reference 11HEALTHhealth.govt.nzVisit source
- Reference 12THELANCETthelancet.comVisit source
- Reference 13NCBIncbi.nlm.nih.govVisit source
- Reference 14AADaad.orgVisit source
- Reference 15CANCERcancer.govVisit source
- Reference 16NATUREnature.comVisit source
- Reference 17WHOwho.intVisit source
- Reference 18DERMNETNZdermnetnz.orgVisit source
- Reference 19NCCNnccn.orgVisit source
- Reference 20NEJMnejm.orgVisit source
- Reference 21AAOaao.orgVisit source
- Reference 22EPAepa.govVisit source