Epidemiology and risk factors for malignant melanoma [Epidemiologie und risikofaktoren des malignen melanoms]

The incidence of cutaneous melanoma is increasing worldwide. In Germany an incidence of 12-14 cases per 100,000 inhabitants and year is registered; in Australia the incidence exceeds 50 cases. Mortality due to cutaneous melanoma is higher than for all other nonmelanoma skin cancers together. At the beginning of the 1990s, mortality in Germany reached 2.6 cases per 100,000 inhabitants and year for males and 1.7 cases for females. The most important prognostic factor in melanoma is Breslow's tumor thickness. Therefore, early detection significantly contributes toward lowering mortality. In 40% of patients melanoma already occurs before the age of 50 years. In 40% of females melanoma develops on the lower extremity and in the same percentage of males melanoma occurs on the upper trunk. Risk groups for melanoma development can be defined based on the total number of acquired melanocytic nevi, the number of atypical melanocytic nevi, and the previous occurrence of cutaneous melanoma in the patient or his family. Persons at elevated risk should be regularly screened by a dermatologist. In cases of significant change or growth of nevi in adults, the lesion should be excised and examined by histopathology. In patients with high numbers of atypical nevi, these should be documented by computed dermoscopy and the images stored. Recommendations for screening of persons at elevated risk are outlined. Primary preventive measures may help to lower the incidence of melanoma over a longer time. Particularly prevention of sun exposure in childhood may be suitable to prevent nevus development and thereby lower the risk of later melanoma development. Sun protective clothing and sun protective behavior are required to inhibit nevus and melanoma development; use of sunscreens alone does not seem to be suitable for melanoma prevention.