All cases of cutaneous malignant melanoma, CMM, diagnosed in Northern Ireland between 1974-1978 were reviewed, classified and followed up until the end of 1984. The overall 5 year survival is 54%, among the worst reported in recent literature. Multivariate analysis of these cases confirms some previous findings from other studies, but also reveals features not apparent in univariate analysis. Prognosis worsens with increasing thickness and the presence of ulceration. Likewise histopathological type has an independent effect on survival, ALM having the worst prognosis. Tumour profile emerges as a significant feature affecting prognosis, flat lesions having the poorest outlook, given their thickness. Survival is worse with increasing age. Anatomical site is less important than suggested by previous univariate analysis. Sex has little influence on prognosis when adjusted for the other variables. Cell type and pigmentation are of no prognostic value. Several features including diagnostic delay contribute to the poor overall survival for CMM in Northern Ireland. Educational intervention is essential if this trend is to be reversed.

Summary The results of two 5-year studies, for 1974-78 and 1984-88, of cutaneous malignant melanoma (CMM) in Northern Ireland show changes in the presentation of the disease. Although there is some evidence of earlier diagnosis, the rise in incidence has produced an overall increase in the number of cases with advanced disease.Keywords: cutaneous malignant melanoma; epidemiology; histopathology As the incidence of melanoma continues to rise worldwide, the importance of early diagnosis is underlined. Collection of complete and accurate data is essential to the study of changes in presentation. A baseline study in Northern Ireland looked at all histopathologically confirmed cases of invasive cutaneous malignant melanoma (CMM) occurring during the 5-year period 1974-78 (Gordon and Lowry, 1986a). The majority of these presented with thick, advanced melanomas. The follow-up study confirmed a low 5-year survival rate of 54% (Gordon et al, 1991). The present study repeats the first study as closely as possible for 1984-88. The clinical and pathological presentation of cases for 1984-88 are reported and changes in the pattern of CMM are identified. MATERIALS AND METHODSNorthern Ireland lies between latitudes 54 and 56 degrees north. It has a maritime climate with a daily mean of 3.6 h of sunshine. The population was relatively stable at just over 1.5 million during the study period.Comprehensive lists of all histopathologically confirmed melanomas were obtained from the pathology departments in Northern Ireland, giving a total of 774 cases. For both studies, it is considered that very few cases of melanoma would escape histopathological confirmation in the province. RESULTSThere were 240 cases of invasive CMM for 1974-78 (62 men and 178 women) and 487 for 1984-88 (154 men and 333 women). Between the two periods, a significant increase (P < 0.05) in agestandardized incidence is observed from 3.18 to 6.09 per 100 000 population (men 1.68-3.91, women 4.64-8.19). The female-male ratio has fallen from 2.8: 1 to 2.1:1. Age Melanoma incidence increases with age (Figure 1), and incidence rates have increased across all age groups between the studies. SiteThere is no significant change in overall site distribution between the studies. Between the sexes, however, there are significant difference in site distribution both for 1974-78 (P < 0.005) and for 1984-88 (P < 0.0001), with the head/neck remaining the most common site for men and the leg for women (Table 1). The increase in numbers is greatest for the female leg and the male trunk. The 1984-88 study notes differences in distribution between the sexes for melanomas at subsites on the limbs (excluding the foot). On the upper limb, the forearm-upper arm ratio of lesions is 1.2:1 for women whereas for men the ratio is 3: 1. In contrast, melanomas on the leg in men are divided equally between the thigh and lower leg, while for women melanomas are five times more common on the lower than the upper leg.Tumour type There has been a significant change in tumour type distribution be...

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