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WTF: Why does Vermont have such a high incidence of melanoma? 

Whiskey Tango Foxtrot: We just had to ask...

Published July 31, 2013 at 9:46 a.m.


Apply sunscreen liberally before reading this story. Seriously. Vermont has one of the highest rates of melanoma in the country: About 29 out of every 100,000 Vermonters had the disease between 2005 and 2009, compared with just 19 of every 100,000 Americans overall, according to the U.S. Center for Disease Control and Prevention. The skin cancer has a lot of potential causes, but it tends to develop when pale white people spend too much time exposed to the sun. And if you’re living in Vermont, the U.S. Census says there’s a 95.4 percent chance you’re white.

While that may explain why Vermont had the highest rate of new melanoma diagnoses in the U.S. between 2001 and 2005, it doesn’t tell us why Bennington County has the highest rate of melanoma diagnoses of any county in the nation — 179 percent above the national average. More on that in a moment.

What do all these stats mean to the average person? The good news is that if you’ve got a strange-looking, possibly painful mole, your chances of survival are pretty good. The vast majority of melanoma cases in Vermont — about 90 percent — are curable by a quick session under the knife, says Dr. Claire Verschraegen, codirector of the Vermont Cancer Center at the University of Vermont. The doc removes the cancerous skin before it spreads, and you’re good to go; most patients never have a recurrence.

The key, Verschraegen adds, is early detection. As soon as the cancer passes through the basal membrane, a thin layer of tissue under the skin, things get worse.

“We measure the depth of invasion in millimeters from the basal membrane,” she says. “If you have, let’s say, a 1-millimeter one, your rate of cure is close to 90 percent. If it’s more than 2 millimeters, then it goes down to around 80 percent, and if you have a positive lymph node or a very thick lesion, more than 4 millimeters, it goes down to 50 percent.”

Before breaking the bad news to your farmer neighbor, consider this: Those who regularly spend lots of time in the sun are actually less at risk for melanoma than those who spend their days inside or wearing business suits and then venture outside for a prolonged period. In short, you should be more worried about your accountant who slaves away at his desk through tax season and then takes a Caribbean vacation.

That’s why Vermonters, who spend nine months of the year cooped up under compact-fluorescent lights and bundled in three layers of sweaters, are at such great risk when they take advantage of the short summers to binge on sunshine.

Back to that sunscreen. Verschraegen says spending as few as 10 or 15 minutes in the sun can cause fair-skinned people to burn, and burning just once a year considerably ups the odds of melanoma. People who tan without burning have much lower chances of melanoma than those who burn once and then tan — or, worse, those who never tan and always burn.

Which body parts are most susceptible? For male Vermonters, it’s the trunk; female Vermonters are most likely to get melanoma on their legs. Think about summer attire and that makes sense. Men roam around shirtless, while women stay cool in short shorts and skirts. So guys: Unless you have a jungle of back hair, keep your shirt on. (And if you do have a jungle of back hair, consider keeping it on, too.) Ladies: Pants and longer skirts will help lower your chances of contracting skin cancer.

As for Bennington County, no one is quite sure why Vermont’s southwestern-most region has such a high rate of melanoma. Specifically, the Manchester area has more than double the state average of cases per capita. Vermont Department of Health spokesman Robert Stirewalt says state epidemiologists are looking into it.

Verschraegen says she isn’t aware of any studies focused specifically on Bennington County. But she likens its high melanoma concentration to that of the Mormon population in Utah, where a mutation in what is known as the p16 gene leads to an especially high chance of developing melanoma.

“We don’t really know why there is a cluster, so the first explanation, to me, would be a genetic trait in that local population,” Verschraegen says. “Unless there is a carcinogenic element in the environment that specifically gives rise to melanoma, and I don’t know what that would be, either.”

Here in Vermont, there’s a carcinogenic element in the environment all summer long: the sun. So keep your clothes on and your sunscreen handy.

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