December 04, 2019
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Head and neck melanoma incidence rises among children, adolescents, young adults

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Nosayaba Osazuwa-Peters, PhD, PDS, MPH, CHES
Nosayaba Osazuwa-Peters

Increased awareness of melanoma among the general public has led many people to adopt sun-protection practices, perform melanoma self-exams and take precautions for their children.

Public health campaigns advocating these and other preventive measures appeared to have had an effect, as incidence of invasive melanoma decreased among adolescents and young adults between 2006 and 2015, according to results of study by Paulson and colleagues published in JAMA Dermatology.

However, in a separate study published in JAMA Otolaryngology-Head & Neck Surgery, researchers reported an increase among young people in head and neck melanoma, which has lower rates of survival compared with melanomas in other regions of the body. Results of that study, by Nosayaba Osazuwa-Peters, PhD, PDS, MPH, CHES, assistant professor and director of epidemiology and population health research at Saint Louis University School of Medicine, and colleagues, showed incidence of head and neck melanoma increased by 51% among children, adolescents and young adults in the U.S. and Canada between 1995 and 2014. The increase in the U.S. appeared to be driven by white males aged 15 to 39 years.

“Head and neck melanoma is not the most common melanoma; it’s only one-fifth of melanomas that are diagnosed,” Osazuwa-Peters said in an interview with Healio. “However, the fact that the 5-year survival of head and neck melanoma is worse than the 10-year survival for any of the other sites leads us to wonder whether some sort of caveat or preventive measures should be in place.”

Osazuwa-Peters spoke with Healio about the results of his study, the need for increased precautions against head and neck melanoma, and the role the lay public can play in early detection of head and neck melanoma.

Question: How did your study differ from that of Paulson and colleagues, who observed a decline in invasive melanoma among adolescents and young adults?

Answer: Our study focused exclusively on head and neck melanoma. Also, we grouped adolescents and young adults (AYAs) according to the NCI-defined age range for AYAs with cancer (15 to 39 years) and did not split them into 10-year age groups. Finally, even if we had found decreased incidence, our message would have remained the same: It is critical that parents and families not minimize the risks associated with unsafe sun exposure or tanning practices because of any perceived diminished risk for melanoma among younger populations. Sustained, consistent and tailored public health messaging about melanoma prevention remains essential irrespective of sex or age group.

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Q: Why do you think the incidence of head and neck melanoma has increased so substantially among children and adolescents?

A : Our study wasn’t designed to show cause; it was to show trends over time, to describe what’s out there and make people aware of it. The average age of melanoma diagnosis is about 63 years. So, typically, we’d be looking at adult cases and thinking the risk might be reduced among children. What we’ve shown from our study is that, whereas head and neck melanoma is relatively rare among younger people, it is increasing in this population.

Q: Some clinicians think melanoma is overdiagnosed. Is it possible that this was the case in your study?

A: You could argue that the possibility of overdiagnosis exists for most cancers. The U.S. Preventive Services Task Force formulates recommendations to prevent overdiagnosis. For melanoma, the USPSTF does not recommend asymptomatic screening. It does not advise people to get screened unless there is a risk factor for it. So, yes, there is a chance of overdiagnosis, but we also need to be careful to avoid underdiagnosis, especially because we don’t generally focus on the population this young, as the average age of diagnosis of melanoma is over 60 years.

Q: How have your findings differed from common beliefs about melanoma?

A: There is a good deal of emphasis and legislation regarding tanning beds and risk factors like that, but it seems to be focused mainly on women and young girls, who seem to have more cases of melanoma in other body sites. However, our study showed it was boys who were driving the increase in head and neck or head and scalp melanoma. So, it could be that we need to make our messaging more preventive and gender neutral.

Q: Many of the melanomas found in your study were on the scalp, the external ear and the neck. Are these areas parents may not consider when applying sunscreen?

A: It’s possible. It could be a lot of different things. Our study showed that head and neck melanoma is more common in males than in females. Who is more likely to be bald by age 39? We also found it to be more common among whites than blacks. Plus, when you think about our cultures in the U.S. and Canada, we are hiking more and spending more time outdoors, which is a good thing. But how often do we apply simple preventive measures such as wearing a hat or things like that? If the USPSTF is not recommending asymptomatic screenings, the dermatologist or a primary care doctor is not going to wake up one day and decide to check a child’s scalp. This is part of the reason we think this might be a good opportunity for medicine and public health to work together. People who, as part of their everyday process, might look at a scalp could help us pick up on these things. There have been cases where lay people in everyday settings are the first to recognize when something looks strange in the scalp.

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Q: Can you give some examples of this?

A: Other studies and interventions have shown that when you empower lay people through training, they become foot soldiers. No doubt, a dermatologist would recognize melanoma better than most others, but how often do we go to a dermatologist without a reason? If a barber is trained to look at the scalp, when they see that discoloration, they aren’t just going to say, “Oh, that’s another birthmark or a mole.” They’re trained to understand the way things look, the dimensions. Awareness has increased during the past 30 years about the different forms of melanoma, with criteria to identify early disease such as ABCDE (asymmetry, border irregularity, color, diameter and evolution). We need to put that information out there in the hands of people who might not have the clinical knowledge but can recognize something suspicious. We don’t want to contribute to overdiagnosis. We should be empowering nonclinicians who are capable of performing a noninvasive visual inspection of the scalp, or folks who could look at the scalp and say, “I don’t know what I see, but I see something. You might want to check this out.” – by Jennifer Byrne

References:

Bray HN, et al. JAMA Otolaryngol Head Neck Surg. 2019;doi:10.1001/jamaoto.2019.2769.

Paulson KG, et al. JAMA Dermatol. 2019;doi:10.1001/jamadermatol.2019.3353.

For more information:

Nosayaba Osazuwa-Peters, PhD, PDS, MPH, CHES, can be reached Saint Louis University Cancer Center, 3635 Vista Ave., 6th Floor Desloge Towers, St. Louis, MO 63110-2539; email: nosazuwa@slu.edu.

Disclosures: Osazuwa-Peters reports no relevant financial disclosures.