Skin Cancer Incidence: The Effects of Surveillance and Migration-Reply

In Reply. —  Dr Stern raises some interesting points. Although the changes in "sun exposure habits" may have been gradual, the rises in incidence have been major. Indeed, sizable rises in melanoma rates in other registries antedate our study by several decades. In Connecticut, the incidence of melanoma (among males and females combined) rose from 1.0 per 100 000 to 3.6 per 100 000 in the 25 years between 1935 through 1939 and 1960 through 1964.¹ Until this cancer became relatively common, such rises in incidence were ignored. Changes in incidence of squamous cell skin cancer went unreported, as data were not collected by registries.Interviews with clinicians who have been present over most of the study period revealed no changes in clinical practice with respect to management of skin lesions. However, we have no objective, quantifiable data to address this issue. Further, we note in the text that