Study suggests prevention efforts are having an effect on melanoma in Pa., N.J.

Free skin cancer screenings on Jersey Shore beaches. Laws cracking down on indoor tanning. Melanoma prevention programs for children as young as 3.

Efforts such as these may explain why a new analysis has found a small but heartening decline in melanoma cases and deaths in most Northeastern states, in contrast to trends for the deadliest skin cancer in the rest of the country.

The new study, led by dermatologist Robert Dellavalle of the Denver Veterans Affairs Medical Center and published recently in JAMA Dermatology, compared melanoma deaths and incidence by region for 2003 and 2013.

The Northeast region included New England plus Pennsylvania, New Jersey and New York.

Most New England states saw drops in both rates. The researchers noted that the Melanoma Foundation of New England, founded in 1999, became very active during the study period. Its recent innovations include free sunscreen dispensers in recreational areas in Boston and other cities.

In Pennsylvania and New Jersey, the analysis found that melanoma deaths per 100,000 residents declined (from 2.9 to 2.3 in the Keystone State and from 2.5 to 2.4 in the Garden State). Incidence rose, but that may reflect more awareness and diagnosis of skin cancer. (Per 100,000, Pennsylvania cases rose from 16.8 to 24.3, while New Jersey rose from 19.1 to 22.3.) New York also saw deaths drop while incidence rose.

By contrast, both rates climbed in most Midwestern states studied. Cases rose in the South and West, although death rates varied in those regions.

"Before, we didn’t even know there was a regional difference," Dellavalle said. "If you see a difference, it's always good to try to figure out why. I think there is more regulation of indoor tanning in the Northeast and probably better education through the melanoma foundations in that area."

Both Pennsylvania and New Jersey require parental consent for 17-year-olds to use tanning beds and ban anyone younger than 17. Tanning salons must pay annual registration fees, post warning signs, provide protective eyewear, and keep records of customers' visits.

Many public health agencies in both states have educational programs. In Chester County, for example, the department offers presentations that can be tailored to adults, outdoor workers, and elementary or high school students - even preschoolers and those in day-care centers.

Nonprofits are also making a difference. The Enright Melanoma Foundation in Summit, N.J. - founded in 1999 in honor of a local doctor who died of melanoma at age 37 - offers free, interactive, 20-minute online courses about sun safety for three age groups: 5 to 8, tweens, and ages 13 and over. Since the launch in May, has been taken by more than 2,500 children, teachers, lifeguards, camp counselors, scouting leaders and parents.

Enright also works with New Jersey's Melanoma Task Force on “Choose Your Cover," which offers free skin cancer screenings at  the Jersey shore, public pools, and recreation centers.

"Many people still think a tan is a healthy glow, not damaged skin," said Enright Foundation executive director Janet Horowitz. "But I think kids are starting to learn. It really takes a cultural change, like attitudes about smoking."

And just as many college campuses have gone tobacco-free, Dellavalle co-leads a campaign to get them to adopt anti-indoor-tanning policies.

His new analysis did not attempt to look at demographic factors that play a role in melanoma rates.

Despite the regional variations he found, the overall melanoma picture remains grim, with national studies showing increases in incidence and deaths since 1980. The American Cancer Society estimated there were about 76,000 new diagnoses, and 10,000 deaths in 2016.