Patient presentation, skin biopsy utilization and cutaneous malignant melanoma incidence and mortality in northern Italy: Trends and correlations

Abstract

Background The global increase in incidence of cutaneous malignant melanoma (CMM) occurring in the past decades has been partly attributed to increased diagnostic scrutiny of early lesions, with a potential phenomenon of overdiagnosis. The reported positive linear relation between skin biopsy rate and incidence of early CMM is compatible with this hypothesis. Objectives We explored the ecological association between the trends in annual dermatologic office visit rates, skin biopsy rates, incidence rates of in situ and invasive CMM by tumour thickness category, and CMM mortality rates in the Emilia‐Romagna Region (northern Italy). Methods Four cancer registries covering a population of 2,696,000 provided CMM incidence data for the years 2003–2017. Dermatologic office visit rates and skin biopsy rates were calculated using the Regional outpatient care database. All rates were age‐standardized. Trends were described with the estimated average annual per cent change (EAAPC). Correlations were tested with the Spearman correlation coefficient. Results Incidence increased significantly. The increase was steeper for in situ CMM (EAAPC: men, 10.2; women, 6.9) followed by CMM <0.8 mm thick (9.1; 5.2), but the rates grew significantly for most subgroups of CMMs ≥0.8 mm thick. Mortality decreased significantly among women (−2.3) and non‐significantly among men. For dermatologic office visit rate and skin biopsy rate the EAAPC were, respectively, 1.7 and 1.8 for men and 1.2 and 0.9 for women. Annual dermatologic office visit rate correlated with skin biopsy rate in both sexes. However, the proportion of skin biopsies out of dermatologic office visits was constant across the years (range: men, 0.182–0.216; women, 0.157–0.191). Conclusions In Italy, the increasing CMM incidence trend is, at least in part, genuine. Overdiagnosis—if any—is due to an increased patient presentation at dermatologic offices and not to a lower dermatologic threshold to perform biopsy.

Self-detected Melanomas are Thicker Regardless of Patient’s Complexity: A Retrospective Analysis

“…It has also been suggested that the potential increase in morbidity and costs associated with overdiagnosis of thin lesions due to regular DSE, could be outweighed by the reduction in melanoma burden, given a genuine increase in the incidence of melanoma (4), such as reported in our district (5).…”

Preliminary Analysis of the Melanoma Multimedia Educational programme for general practitioners on behalf of the Italian Melanoma Intergroup

“…[5][6][7][8] Furthermore recent Italian data using a population cancer registries have suggested an overload primary care physician referral for a suspicious lesions for an increased patient presentation at dermatologic offices and have recommended a better GP triage in the referral patients. 11 A recent review has been highlighted the importance and the effects of educational course on skin cancer detections.…”

North-south differences in incidence and surveillance of cutaneous malignant melanoma in Italy

“…The Emilia-Romagna Region and the Sicily Region were selected for the study for two reasons: first, their different latitude and, second, the fact that the local investigators had access to the Regional outpatient care files, which contain the individual electronic records of services delivered in outpatient clinics of public health facilities. Among the cancer registries participating in the research project, 3,[14][15][16] four (Parma, Modena, Ferrara and Romagna) out of five in the Emilia-Romagna Region and three (Catania-Messina-Enna, Siracusa and Ragusa) out of four in the Sicily Region (Online Supplementary Figure S1) met the following eligibility criteria : (1) having CMM incidence and mortality data for ⩾10 consecutive years; (2) having incidence data both for in situ and invasive CMM; and (3), with respect to the latter, being able to provide tumour thickness information for at least 75% of CMM cases on an annual basis. On 1 January 2023, people living in their registration areas totalled 2,606,465 in the Emilia-Romagna Region and 2,775,019 in the Sicily Region.…”

“…The results published so far allow new insights into the promising results of national efforts for the control of the disease. 3,[14][15][16] As a part of this project, we have carried out a study with the primary objective of comparing the time trends in overall and Breslow tumour thickness-specific incidence rates, CMM mortality rate, dermatologic office visit rate and skin biopsy rate between the Emilia-Romagna Region (northern Italy) and the Sicily Region (southern Italy). We used the 'number needed to screen' for a diagnosis of CMM and the five-year net survival (NS) rate as secondary end points.…”