Plains Regional Medical Group Internal Medicine, Clovis, NM 88101, USA.
Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15232, USA.
Med Sci (Basel). 2021 Oct 20;9(4):63. doi: 10.3390/medsci9040063.
Melanoma accounts for 1.7% of global cancer diagnoses and is the fifth most common cancer in the US. Melanoma incidence is rising in developed, predominantly fair-skinned countries, growing over 320% in the US since 1975. However, US mortality has fallen almost 30% over the past decade with the approval of 10 new targeted or immunotherapy agents since 2011. Mutations in the signaling-protein BRAF, present in half of cases, are targeted with oral BRAF/MEK inhibitor combinations, while checkpoint inhibitors are used to restore immunosurveillance likely inactivated by UV radiation. Although the overall 5-year survival has risen to 93.3% in the US, survival for stage IV disease remains only 29.8%. Melanoma is most common in white, older men, with an average age of diagnosis of 65. Outdoor UV exposure without protection is the main risk factor, although indoor tanning beds, immunosuppression, family history and rare congenital diseases, moles, and obesity contribute to the disease. Primary prevention initiatives in Australia implemented since 1988, such as education on sun-protection, have increased sun-screen usage and curbed melanoma incidence, which peaked in Australia in 2005. In the US, melanoma incidence is not projected to peak until 2022-2026. Fewer than 40% of Americans report practicing adequate protection (sun avoidance from 10 a.m.-4 p.m. and regular application of broad-spectrum sunscreen with an SPF > 30). A 2-4-fold return on investment is predicted for a US sun-protection education initiative. Lesion-directed skin screening programs, especially for those at risk, have also cost-efficiently reduced melanoma mortality.
黑色素瘤约占全球癌症诊断的 1.7%，是美国第五大常见癌症。在发达的、以白种人为主的国家，黑色素瘤发病率正在上升，自 1975 年以来，美国的发病率增长了 320%以上。然而，过去十年间，随着自 2011 年以来批准了 10 种新的靶向或免疫治疗药物，美国的死亡率下降了近 30%。半数病例存在信号蛋白 BRAF 的突变，针对这些突变使用口服 BRAF/MEK 抑制剂联合药物，而检查点抑制剂则用于恢复可能因紫外线辐射而失活的免疫监视。尽管美国的总体 5 年生存率已上升至 93.3%，但 IV 期疾病的生存率仍仅为 29.8%。黑色素瘤在白人、老年男性中最为常见，平均诊断年龄为 65 岁。没有保护措施的户外紫外线暴露是主要的风险因素，尽管室内晒黑床、免疫抑制、家族史和罕见的先天性疾病、痣和肥胖也会导致黑色素瘤。自 1988 年以来，澳大利亚实施了初级预防措施，如开展防晒教育，增加了防晒霜的使用，并遏制了黑色素瘤的发病率，澳大利亚的黑色素瘤发病率在 2005 年达到顶峰。在美国，黑色素瘤的发病率预计要到 2022-2026 年才会达到峰值。不到 40%的美国人报告采取了适当的防护措施（上午 10 点至下午 4 点避免阳光直射，并定期使用 SPF>30 的广谱防晒霜）。一项针对美国防晒教育计划的投资回报率预计为 2-4 倍。针对高危人群的病变定向皮肤筛查计划也以具有成本效益的方式降低了黑色素瘤的死亡率。
