[Necessity of the development of a melanoma prevention program in Hungary - in the light of epidemiological data]

Abstract

The prevention and the early diagnosis of melanoma malignum are essential because of the aggressive spreading and poor therapeutic response of the tumor. Since survival mainly depends on the tumor stage, in the first part of the Ph.D. thesis the stage distribution of melanomas was assessed in the melanoma patients treated at the Department of Dermatology, Dermatooncology and Venerology, Semmelweis University. This work filled a gap, because the Hungarian National Cancer Registry, similarly to other cancer registries, does not include the tumor stages. The results of the assessment showed that most of the patients (43.8%) belonged to stage IA, while only 0.4% of them were in stage IV. In comparison with international studies from Western Europe, Australia and the United States, the distribution of our patients was highly favorable concerning stages IA and IV. To assess the risk of melanoma among special work circumstances (Nuclear Power Plant of Paks) the Department of Dermatology, Dermatooncology and Venerology organized an oncodermatological screening. The results of the screening confirmed that melanoma incidence was not elevated among the nuclear industry workers compared to the general Hungarian population. Among the 556 examined workers we found one melanoma in situ, and the medical history of this patient suggested that UV exposure rather than ionizing radiation could have been the cause of this tumor. Our results also underline the necessity of analyzing skin effects of UV light to avoid false positive correlations. The risk of second primary cancers among melanoma survivors was also assessed in our Department. The findings suggest that the risk of all second primary tumors significantly, 11-15-times increased after having a former melanoma, compared to the general population. The higher risk was mostly caused by the elevated incidence of second primary melanoma and non-melanoma skin cancers. Besides skin tumors, the risk of some internal malignancies was also significantly higher. Our results emphasize that the regular oncologic control is crucial after having melanoma in order to diagnose a second skin or internal malignancy early. Melanoma awareness, primary and secondary prevention programs would be highly necessary to decrease the number of new melanomas, to increase the rate of the early diagnosed tumors and to improve survival.