Comparison of melanoma incidence and trends among youth under 25 years in Australia and England, 1990–2010

Abstract

White populations in Australia and England share many genetic and phenotypic characteristics due to common ancestry, but Australians experience far higher rates of melanoma due to higher ambient ultraviolet radiation (UVR) levels. To gain insight into the role of UVR on melanoma development early in life, we used national cancer registration data and compared recent incidence rates and long-term trends of primary invasive cutaneous melanoma in Australian and English youth aged 0-24 years diagnosed 1990-2010. Incidence rates and standardized rate ratios (SRRs) with 95% confidence intervals (CIs) for 2006-2010 were calculated and incidence trends across the whole period were examined using JoinPoint regression. In Australian youth, overall melanoma incidence was double that in English youth (2.2 and 1.1 per 100,000, respectively). While melanoma rates were similarly rare among children <10 years in both countries, in subsequent 5-year age groups, incidence was significantly higher in Australia compared to England. Melanoma incidence among 15-24 year olds significantly increased by more than 2% per year in both sexes in England. However, after an initial non-significant increase, Australian rates for this older age group significantly decreased by 6.0% (95% CI, 28.2 to 23.8) per year in females from 1997 and decreased by 12.4% (95% CI, 220.3 to 23.8) per year in males from 2004. Long-standing primary prevention strategies targeted at curbing UVR exposure appear to have been effective in mitigating incidence trends in Australian youth, but decreases in incidence in English youth are yet to be observed.

Incidence and relative survival of melanoma in children and adolescents in the Netherlands, 1989–2013

“…The increasing trend of paediatric melanoma incidence in the Netherlands seems to have declined since 2005. Trends in incidence rates also decreased in the United States and Sweden since the mid‐1990s, and since 2004 in Australia . The authors attribute the decreasing incidence rates to a change in sun‐related behaviour due to prevention campaigns.…”

“…Regarding diagnostic accuracy, in the literature, numbers range from 57 to 89% accuracy upon histological review . In studies describing histological subtype of paediatric melanoma, many melanomas were often coded as ‘melanoma not otherwise specified’ (10 to up to 50%) …”

“…In the Netherlands, paediatric melanoma accounted for 5% of all paediatric malignancies up the age of 17 years in 2016 . In North American and European countries, paediatric melanoma incidence rates vary from about 0.3 to 1 per 100 000 person‐years . In the past 2–3 decades, an annual increase in paediatric melanoma of 1–4% has been reported in the United States and UK .…”

Whole genome sequencing of melanomas in adolescent and young adults reveals distinct mutation landscapes and the potential role of germline variants in disease susceptibility

“…The main mutagenic process associated with the development of adult cutaneous melanoma is exposure to ultraviolet radiation (UVR) . There is growing evidence that this is also the case in AYA melanomas, with epidemiological studies showing high ambient UVR countries, such as Australia, have higher rates of melanoma in the AYA population than low ambient UVR countries such as England . This is supported by molecular profiling of AYA melanoma genomes, which found a high proportion of UVR‐induced DNA damage, as characterized by C > T or CC > TT nucleotide transitions .…”

Challenges in assessing the sunscreen‐melanoma association

“…Studies on childhood melanoma were included in the qualitative synthesis but excluded from the meta‐analyses because UV exposure does not seem to be a risk factor in the aetiology of melanoma occurring before 15 years of age …”