Maignant melanoma and oral cancer visible to dentists in perspective

Objectives: The mouth and pharynx are the sixth most common sites for cancer with 300,000 new cases reported annually but 13.9% of these cancers occur in sites not accessible in an oral examination. Malignant melanoma (MM) accounts for 4% of skin cancers with 8,110 projected deaths in 2007 – of which 30% occur in the head and neck although the skin of the head and neck accounts for only 9% of the body's surface. The study analyzes recent incidence and mortality trends of MM of the face (MMOF) and compares them to visible oral cancers (VOC) rates (excluding hypopharynx, nasopharynx and tonsil).

Methods: From 1994-2004 Surveillance Epidemiology and End Results (SEER), age, race, site-specific trends of VOC and MMOF were computed. Results: Age-adjusted incidence per 100,000 for VOC and MMOF were 5.46, 0.89 (CI; 5.31- 5.79; 0.79-0.99) for Hispanics, 9.55, 4.16 (9.52-9.75; 4.09-4.23) for Whites and 9.86, 0.11 (9.68-10.36; 0.07-0.15) for Blacks, respectively. Incidence of MMOF in Hispanics is exceeded by rates for VOC, tongue and gingiva. MMOF rates in Whites exceed any component VOC sites. Annual percent change (APC) for VOC and MMOF is -1.9 (p<0.01); 1.84 (p<0.01), respectively. APC trends for VOC have decreased but have increased for MMOF. Survival rates of VOC and MMOF for Whites and Blacks are 62.0 (SE; 0.4), 38.6 (1.1); and 91.5 (0.7) and 72.7 (16.3), respectively. Conclusions: Incidence of MMOF is increasing. VOC incidence is 62.98% of all the oral cancers. Incidence for MMOF is high for Whites and Hispanics. After excluding non-visible sites, VOC rates are high and racial disparity exists in the incidence and five year survival rates. By not excluding inaccessible sites, data obtained overestimates the benefit of oral cancer screening programs based on dental examinations in early detection and prevention of oral cancer.