New AAD program 'Be Sun Smart' ready for battle

San Francisco - A new strategic plan from the American Academy of Dermatology (AAD) will hopefully help dermatologists win the war against skin cancer, says Darrell S. Rigel, M.D.

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The primary message to be disseminated advocates minimizing sun exposure rather than total avoidance and will center on the "Be Sun Smart" theme, urging the public to seek shade, limit unprotected sun exposure, avoid tanning beds and acquire vitamin D safely.

"I believe that we can win the war against skin cancer if we commit enough resources to be effective and use the right metrics and feedback to evaluate how we are doing. Most importantly, we also need the will to win, but perhaps that is the easiest part for dermatologists. Equipped in those ways, we will hopefully see a halt to the rising number of new skin cancer cases and a marked decrease in lifetime melanoma and skin cancer risk over the short to medium term. Then, we can declare victory," says Dr. Rigel, clinical professor of dermatology, New York University School of Medicine, New York.

Speaking at the 64th Annual Meeting of the AAD in March here, Dr. Rigel described how the task force analyzed what would be needed to win the war and developed a road map to victory.

Identifying benchmarks

Fundamental to knowing whether the war is being won and when victory can be declared is an understanding of the current magnitude of the problem and the current status of efforts to prevent skin cancer and reduce its mortality, as well as identification of the appropriate endpoints for measuring success.

The most recent epidemiologic data on skin cancer from the National Cancer Institute highlight the seriousness of the present situation. The 2006 Surveillance, Epidemiology and End Results (SEER) data estimate that there will be almost 1.5 million skin cancers diagnosed in the United States, including more than 60,000 cases of invasive melanoma and more than 50,000 in situ melanomas. In addition, more than 600,000 Americans are living with melanoma and almost 20 million living Americans have had a nonmelanoma skin cancer.

Current estimates on lifetime risk indicate Americans have a 1 in 60 chance of having an invasive melanoma, but if current trends in rising rates continue, that lifetime risk will reach 1 in 50 by 2010. One American dies each hour from skin cancer and melanoma incidence is rising faster than that of any other cancer in men, while ranking as the second fastest rising cancer in women.

In determining how to measure success, the committee considered the relationship between incidence and mortality and determined that improvements in both incidence and mortality rates will be important metrics of the campaign's success. Dr. Rigel uses an example comparing pancreatic cancer and skin cancer to illustrate that point.

"For pancreatic cancer, incidence equals mortality because that disease has a high death rate and low early detection rate. In contrast, for melanoma and other skin cancers, incidence and mortality rates differ because of the efficacy of early detection and the low death rates associated with these malignancies," he explains.

With both incidence and mortality rates as targets, both primary and secondary prevention efforts will be important. The primary intervention aims to motivate changes in risk behaviors and will impact incidence whereas secondary prevention involves improving early detection in persons with a history of skin cancer to reduce mortality.