Watch your back this summer: data reveals most deadly skin cancer in Malta

A study published in the Malta Medical Journal highlights the importance for individuals to have their backs regularly checked since this is the commonest primary melanoma site in cases leading to death. The back (22%) was followed by the hands and feet (15%) and by the legs (13%).

“The back should be emphasized in educational campaigns so that patients ensure that this part of their body is checked regularly by other family members, their doctor or friends, or else with the use of a mirror,” the authors of the study recommend.

Mole mapping in selected cases can also be useful as a baseline photographic record for long-term screening, in order to allow early detection of any changes in pigmented lesions, especially in areas that are difficult to monitor.

International studies show that in Caucasian populations, including the Maltese population, melanoma is more frequently reported on the backs and shoulders in men and on the lower limbs in women.

The authors also believe in the importance of awareness campaigns to advise the public not to overexpose their skin to the sun together with campaigns to encourage earlier detection and treatment of melanomas when they present on the skin or accessible parts of the body.

“With this three-pronged approach of primary prevention of melanoma, early detection and treatment, and improved management of patients with metastatic melanoma, we hope that as few patients as possible will succumb to this cancer.”

The study also confirms that death from melanoma is highest in patients over 60 years of age.

All 87 patients whose death certificates listed metastatic melanoma as the cause of death between 2007 and 2016 were included in the study. Of these 45 were male and 42 were females.

The average age at diagnosis of the primary melanoma of 64.3 years with the age ranging from 23 years to 92 years, while the average age at death was 67.9 years. The average duration of survival after diagnosis of primary melanoma was 34.7 months.

Melanoma is considered as the most serious form of skin cancer, due to the significant risk of death. Risk factors for this type of cancer include sun exposure, increasing number of moles on the skin, the presence of atypical moles, fair skin, family or personal history of melanoma and increasing age.

The Maltese are particularly prone to skin cancer due because the islands have a high UV index for several months of the year with the population being exposed to intense sunlight particularly in the spring and summer months.

The majority of the population is of skin phototype II to IV ranging from fair to medium brown. This means that a significant percentage of the population is susceptible to skin burning when exposed to the sun, which is a risk factor for the development of melanoma. The risk of melanoma is considered to be much higher for whites and lower for skin phototypes V and VI (dark brown and black).

Rise in melanoma

In Malta melanoma incidence has been on the increase over the past 20 years, a trend which has been observed in white populations worldwide.

The standardised incidence for malignant melanoma in Malta increased from 3.7 per 100,000 population per year for males and 5.1 for females between 1993-1997, to 10.1 per 100,000 population per year for males and 12.1 for females in 2017.

Despite this, mortality from melanoma has remained stable between 2007 and 2017, presumably because the increased incidence is mainly for thin melanomas with a lower potential to spread to other parts of the body.

Up to a few years ago, surgery was viewed as the only potential treatment. A big leap in the treatment of metastatic melanoma occurred with the advancement of immunotherapy, through the use of cell cycle checkpoint inhibitors and targeted therapies. These treatments became available in Malta in recent years.

The study was written by Liam Mercieca and Susan Aquilina from the Department of Dermatology in Mater Dei Hospital, Alexandra Betts from the Department of Pathology in Mater Deir Hospital and Kristie Tonna from Primary Health Care.

Site of primary melanoma: 87 people died of primary melanoma between 2007 and 2016