Some evidence of a decline or stabilising of death rates from malignant melanoma is now seen in several countries with white populations, at least in some age groups. Knowing why these changes have occurred may help plan primary and secondary strategies to prevent skin cancer. The most likely explanations for the changing mortality from melanoma are increased awareness about early detection, improved sun protection, changes in other environmental factors, and changing natural history (rather than artifacts from the recording of deaths or changes in treatment). The data from McKie's group in Scotland published in this week's issue (p 1117) are unique to Britain because the Scottish melanoma register has ensured good quality population based data with which to study trends in the incidence of melanoma, assessed by Breslow thickness, alongside those for mortality since 1979.
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