The changing incidence and mortality of melanoma in Australia.

For many years Australia has had the highest incidence and mortality rates in the world for melanoma. The incidence rate has been increasing at around 5% per year and the mortality rate, at a rate slightly lower than that. Epidemiology studies have shown clearly that there is both a constitutional and an environmental contribution to melanoma risk, with sunlight being the major risk factor in the environment. The data also clearly show that the thickness of a melanoma at the time it is removed is one of the major determinants of the likelihood of metastasis and thus of the long-term prognosis. Both of these components have been incorporated into major public health programmes aimed at melanoma control in Australia over the last 25 years. Primary prevention programmes have been aimed at reducing the desire for a tan and subsequent overexposure to sunlight. Secondary prevention (early detection) programmes have encouraged people in the community to seek early attention if they notice a new or changing pigmented lesion. Although the age-adjusted incidence and mortality rates for Australia continue to rise, cohort analysis of both incidence and mortality rates reveals that the overall rise is not reflected in all age groups. In the younger cohorts--groups that it has been possible to influence by our public health campaigns in recent decades--both incidence and mortality rates are dropping.