SLU Research: Incidence of Head and Neck Melanoma in Younger Patients Up 51 Percent

The findings by a Saint Louis University School of Medicine team of Haley Bray, M.D., Matthew Simpson, MPH, Jennifer V. Brinkmeier, M.D. , and Nosayaba Osazuwa-Peters, BDS, Ph.D., MPH, of SLU’s Department of Otolaryngology, were published in the latest issue of the journal JAMA Otolaryngology .

ST. LOUIS – Head and neck melanoma among pediatric, adolescent and young adult populations in the United States and Canada increased by 51.1% from 1995 to 2014, per research from Saint Louis University.

Pictured, from left, are Matthew Simpson, MPH, Jennifer Brinkmeier, M.D., Haley Bray, M.D., and Nosayaba Osazuwa-Peters, BDS, Ph.D., MPH, of SLU’s Department of Otolaryngology. Photo by Maggie Rotermund

In the U.S., melanoma is the fifth most commonly diagnosed cancer in both males and females; in Canada, it is the seventh most commonly diagnosed cancer. Between 18-22 percent of new melanoma cases, a type of skin cancer, are found in the head and neck region.

“The team was driven by two things. First, although only one in five melanoma cases happen in the head and neck region, head and neck melanoma has worse survival rates compared to other regions of the body,” Osazuwa-Peters said. “In fact, the five-year survival rate of head and neck melanoma is worse than the 10-year survival rates of other regions of the body.

“Second, although melanoma is diagnosed on the average at age 63, the main risk factors for the cancer, especially sun exposure and use of indoor tanning, are most common among adolescents and young adults.”

Patients from the North American Association of Central Cancer Registries’ Cancer in North America (CiNA) public data set were included in this study. The study population looked at patients from infancy to 39 years of age, diagnosed with head and neck melanoma between 1995 and 2014.

There were 12,462 patients diagnosed with head and neck melanoma in the U.S. and Canada during the study’s time frame; of those, 6,810 cases (54.6 percent) occurred in male patients. Most cases – 11,342 or 91 percent – resided in the United States.

In both countries, the skin of the neck and scalp was the area where most head and neck melanoma were diagnosed. The skin of the lip was the least diagnosed area. Melanoma of the external ear, skin of other parts of the face and the skin of the scalp and neck were all more likely to be diagnosed than that of the skin of the lip.

“This is the first study of head and neck melanoma in adolescents and young adults in the United States and Canada combined,” Osazuwa-Peters said. “While we found a 51 percent increase in incidence during the last two decades in our study, another important finding is that incidence was greater among males than females, especially among white males.”

In the United States, non-Hispanic white patients had the highest age-adjusted incident rates of melanoma, while non-Hispanic black or other race patients had the lowest AAIR.

In both countries combined, the age-adjusted incidence of head and neck melanoma increased 3.71 percent yearly from 1995 to 2001 and 1.21 percent yearly from 2001 to 2014.

“This is an important finding because melanoma in other parts of the body are usually more common in females than males,” Osazawa-Peters said. “It is therefore important that melanoma prevention campaigns do not only focus on young women.”

The data set comprises registries within the National Program of Cancer Registries; the Cancer Committee at the Center for Cancer Care and Research Provincial and Territorial Registries; National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER); and the North American Association of Central Cancer Registry. Current CiNA data includes 93 percent of the U.S. population and 64 percent of the Canadian population.

The research was limited by its inability to make causal inferences from retrospective data. Also, the Canadian data lacked racial/ethnic identifiers, which meant that no racial/ethnic information could be drawn.

“There is room for the lay public to help in early detection,” Osazuwa-Peters said. “For example, barbers and stylists might be the first to spot irregular skin on the scalp before the doctors do. It is therefore important to increase awareness about this cancer. This is in support of the ABCDE campaign that was initiated by experts over 30 years ago, which had the goal of increasing lay public's recognition of early signs of melanoma.”

Other authors include Scott G. Walen, M.D., FRCS, formerly of the department of otolaryngology, Saint Louis University; Zisansha S. Zahirsha, fourth-year student at Saint Louis University School of Medicine; and Scott W. Fosco, M.D., department of dermatology, Mayo Clinic, Jacksonville, Florida and former chair of dermatology at Saint Louis University School of Medicine.

Takeaways

Melanoma is one of the most commonly diagnosed cancers among men and women in the United States and Canada.

Diagnosis is typically later in life, but risk factors include sun exposure and indoor tanning at younger ages

There was a higher incidence of melanoma in the male population versus the female population

Prevention campaigns need to target both female and male populations.

Public health - barbers and stylists may be the first to spot irregular skin.

Early detection is key

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: infectious disease, liver disease, cancer, heart/lung disease, and aging and brain disorders.