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Skin Cancer Incidence: The Effects of Surveillance and Migration

Robert S. Stern, MD
JAMA. 1990;263(13):1766-1767. doi:10.1001/jama.1990.03440130046020.
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To the Editor.—  Drs Glass and Hoover1 present compelling data that the actual incidence of squamous cell carcinoma of the skin is higher than had been indicated by the population-based studies of more than a decade ago. Although habits relating to sun exposure continue to change, it would seem unlikely that there was a sufficient revolution in sun exposure habits among those who differ in date of birth by one to two decades to explain the dramatic increases in risk reported during the last 27 years. Therefore, other explanations may deserve greater emphasis.Medical surveillance for squamous cell carcinoma, especially in older patients, was likely to be far less aggressive during the first decade of the study than in the subsequent two decades. Given the high incidence of tumors among those older than 65 years and the small initial numbers of such patients at Kaiser Permanente, these changes in


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