Recent trends in cutaneous malignant melanoma in the Yorkshire region of England; incidence, mortality and survival in relation to stage of disease, 1993–2003

Abstract

The aim of this study was to investigate recent trends in incidence, mortality and survival in patients diagnosed with malignant melanoma (MM) in relation to stage (Breslow thickness). Cases of primary invasive and in situ MM diagnosed between 1st January 1993 and 31st December 2003 in the former Yorkshire Health Authority were identified from cancer registry data. Over the study period, the incidence of invasive MM increased from 5.4 to 9.7 per 100 000 in male subjects and from 7.5 to 13.1 per 100 000 in female subjects. Most of this increase was seen in thin tumours (o1.5 mm). Thin tumours were more likely to be diagnosed in the younger age groups and be classified as superficial spreading melanoma. In situ melanoma rates increased only slightly. Over the same time period, mortality rates have been relatively constant in both male and female subjects. Five-year relative survival varied from 91.8% (95% CI 90.4 -93.1) for patients with thin tumours to 41.5% (95% CI 36.7 -46.3) for those with thick tumours. In multivariable analyses, Breslow thickness was the most important prognostic factor. Age, sex and level of deprivation were also identified as independent prognostic factors. The trends in incidence suggest that the increase is real, rather than an artefact of increased scrutiny, implying that primary prevention in the Yorkshire area of the UK has failed to control trends in incidence. Mortality, in contrast, appears to be levelling off, indicating that secondary prevention has been more effective.

Incidence of Childhood and Adolescent Melanoma in the United States: 1973–2009

“…Recent evidence suggests the current increased adult melanoma incidence is predominantly explained by an increasing incidence of thinner melanomas. 35,[52][53][54][55] Increased ascertainment of thinner melanomas could explain the observed trends. Although thickness data were available starting in 1988, only 54% of melanomas in our analyses had known thickness.…”

Cutaneous Melanoma In Situ: Translational Evidence from a Large Population-Based Study

“…While presenting the results, we are aware of the fact that although the SEER database provides investigators with a unique opportunity of generating and testing medical hypotheses on an unprecedented large series of patients, under-reporting is a potential limit of this databank, especially when it comes to conditions like CMIS that are routinely and increasingly treated in the outpatient setting. Although most investigators agree that the incidence of skin melanoma is rising worldwide [1][2][3], some have questioned this statement, sustaining either that benign lesions are erroneously included in the calculations [46] or that the increased incidence regards mainly invasive [47] or in situ lesions [48], or even that the incidence is declining [49]. As shown in Figure 1, according to the SEER data, the incidence of CMIS is remarkably increasing over the past 3 decades, which might be related to an actual "epidemic" of CMIS (as postulated for invasive melanoma [36]) but also to the increased attention paid by physicians and the general population to the early diagnosis of skin melanoma (so called "skin awareness") [50 -52].…”

Stage distribution of malignant melanomas in a Hungarian centre

“…Érdemes megemlíteni, hogy a két nagy betegpopulációból az IA stádiumban a SEERcsoport betegei vannak túlsúlyban, az IB-IV-es stádium-ban az arány változik, végig nagyobb százalékot tesznek ki az AJCC-populáció betegei. Nyugat-Európában az újonnan diagnosztizált melanomák 70%-ának vastagsága 1 mm alatti (TNM: 1a,0,0; 1b,0,0) [14,15,16,17], klinikánk betegein él a daganatok 46%-a tartozik ebbe a csoportba. Ez az adat Nyugat-Európa és a SEERcsoport adatainál kedvezőtlenebb, a bulgáriai és a romániai adatoknál -melyek szerint ezekben az orszá-gokban a tumorok kevesebb mint 10%-a 1 mm alattikedvezőbb [18].…”