When Dr. John Kirkwood arrived at the University of Pittsburgh Cancer Institute 20 years ago, he saw 50 to 100 new melanoma cases a year. Now he's seeing 500 new cases a year.

Incidences of melanoma in the United States are increasing more than any other form of cancer -- some 40,000 new cases are diagnosed a year. Yet the overall death rate for melanoma is flat or falling because of better detection, Kirkwood said. This is especially the case among young women; at one time it was the leading cancer death in women 25 to 35 years old.

The mortality rate, however, is rising in men over 50.

"I think women, in general, are fairly attentive to their skin,'' Kirkwood said. "Most of the pigmented lesions they've detected themselves. Conversely, most of the pigmented areas in men are detected by their significant others.''

Last week, the American College Foot and Ankle Surgeons issued a warning about the alarming rise in foot melanoma. Because most people don't consider the feet and ankles when looking for suspicious lesions, melanoma there is often detected late. The fashion appeal of casual shoes, such as sandals in the workplace and at other venues, is increasing overall sun exposure to the feet.

A 2003 study published in the Journal of Foot & Ankle Surgery reported the overall survival rate for melanoma of the foot or ankle is just 52 percent, compared with 85 percent for patients with melanomas on other parts of the body. Any change in an existing mole or pigmented skin abrasion on the foot should be checked, even under the toenail.

Moreover, populations normally at low risk for skin cancer, such as African Americans, Hispanics and Asians, can develop melanomas on their feet. Foot surgeons suggest using sunscreen on the tops and bottoms of the feet and limiting sun exposure.