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6 maltatoday | SUNDAY • 23 MAY 2021 NEWS JAMES DEBONO A study published in the Mal- ta Medical Journal highlights the importance for individuals to have their backs regularly checked since this is the com- monest 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 empha- sized in educational campaigns so that patients ensure that this part of their body is checked regularly by other family mem- bers, their doctor or friends, or else with the use of a mirror," the authors of the study recom- mend. Mole mapping in selected cas- es 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 moni- tor. International studies show that in Caucasian populations, in- cluding the Maltese population, melanoma is more frequent- ly reported on the backs and shoulders in men and on the lower limbs in women. The authors also believe in the importance of awareness cam- paigns 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 ac- cessible parts of the body. "With this three-pronged ap- proach of primary prevention of melanoma, early detection and treatment, and improved man- agement of patients with meta- static 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 in- cluded 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 prima- ry melanoma was 34.7 months. Melanoma is considered as the most serious form of skin can- cer, 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 per- sonal history of melanoma and increasing age. The Maltese are particularly prone to skin cancer due be- cause the islands have a high UV index for several months of the year with the population being exposed to intense sunlight par- ticularly in the spring and sum- mer months. The majority of the popula- tion is of skin phototype II to IV ranging from fair to medi- um 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 pop- ulations 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, pre- sumably because the increased incidence is mainly for thin mel- anomas 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 treat- ment of metastatic melanoma occurred with the advancement of immunotherapy, through the use of cell cycle checkpoint in- hibitors and targeted therapies. These treatments became avail- able in Malta in recent years. The study was written by Liam Mercieca and Susan Aquilina from the Department of Der- matology in Mater Dei Hospital, Alexandra Betts from the De- partment of Pathology in Mater Deir Hospital and Kristie Tonna from Primary Health Care. Site of primary melanoma 87 people died of primary mel- anoma between 2007 and 2016 Back 22 Hands and feet 15 Legs 13 Arms 9 Head/neck 7 Chest/abdomen 5 Eyes 2 Genital 2 Others 4 Unidentified 21 Most mortal skin cancers detected on the back, data from 87 deaths of primary melanoma show WATCH YOUR BACK Melanoma is considered as the most serious form of skin cancer, due to the significant risk of death