The relative contribution of the decreasing trend in tumour thickness to the 2010s increase in net survival from cutaneous malignant melanoma in Italy: a population‐based investigation*

Zamagni, Federica; Bucchi, Lauro; Mancini, Silvia; Crocetti, Emanuele; Maso, Luigino Dal; Ferretti, Stefano; Biggeri, Annibale; Villani, Simona; Baldacchini, Flavia; Giuliani, Orietta; Ravaioli, Alessandra; Vattiato, Rosa; Brustolin, Angelita; Candela, Giuseppa; Carone, Simona; Carrozzi, Giuliano; Cavallo, Rossella; Dinaro, Ylenia Maria; Ferrante, Margherita; Iacovacci, Silvia; Mazzoleni, Guido; Musolino, Antonino; Rizzello, Roverto Vito; Serraino, Diego; Stracci, Fabrizio; Tumino, Rosario; Masini, Carla; Ridolfi, Laura; Palmieri, Giuseppe; Stanganelli, Ignazio; Falcini, Fabio

doi:10.1111/bjd.21051

Cited by 14 publications

(20 citation statements)

References 59 publications

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“…Indeed, a decreasing trend in median tumor thickness over the years (2003–2017) was recently recorded in a registry-based study involving a significant proportion of the Italian population. This trend was paralleled by an increase in 5-year net survival rates, which, however, was only in part attributable to the former, according to the authors [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Dermoscopy Use Leads to Earlier Cutaneous Melanoma Diagnosis in Terms of Invasiveness and Size? A Single-Center, Retrospective Experience

Nazzaro

Passoni

Pozzessere

et al. 2022

JCM

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Background: The incidence of cutaneous melanoma has risen in recent years. The aim of this study was to compare cutaneous melanomas diagnosed at the Dermatology Unit of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy, from 2006 to 2020 and between two specific biennia, i.e., 2006–2007 and 2019–2020. Methods: Retrospective chart review, with dermoscopic image collection, of cutaneous melanomas diagnosed at the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy, from 1 January 2006 to 31 December 2020 Results: A statistically significant increase was shown in the proportions of in situ melanoma and melanoma measuring less than 6 mm, i.e., small-diameter melanoma (SDM), across the studied period (p < 0.001). Moreover, in the biennium 2006–2007, among 220 melanoma diagnoses, 6 were in situ (2.7%), as compared with 68 melanomas in situ out of a total of 236 (28.8%) melanomas diagnosed in the biennium 2019–2020. A statistically significant difference in the proportion of in situ melanoma between the two biennia was demonstrated (p < 0.001). Furthermore, during the first biennium, 27/220 (12.3%) SDM were identified, as compared with 61/236 (25.9%) in the last. A statistically significant difference was shown in the proportion of SDM between the two (p < 0.001). Conclusions: The percentage of in situ melanomas and those that can be detected at a diameter <6 mm has increased. The latter has been shown to be around one-third of excised lesions, thus undermining the practicality of the ABCD mnemonic. Dermoscopic criteria for SDM are needed to help further refine melanoma diagnosis.

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Section: Discussionmentioning

confidence: 99%

Dermoscopy Use Leads to Earlier Cutaneous Melanoma Diagnosis in Terms of Invasiveness and Size? A Single-Center, Retrospective Experience

Nazzaro

Passoni

Pozzessere

et al. 2022

JCM

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“…In two previously published articles, we have shown that the upward incidence trend is still ongoing for both sexes (despite a risk decrease being observed in the most recent birth cohorts) 31 and that the rates of thin CMM are rising more steeply. 32 This has provided the rationale for a third round of analysis aimed at exploring the ecological association between the trends in annual dermatologic office visit rates, skin biopsy rates, incidence rates of in situ and early invasive CMM, and CMM mortality rates in a large administrative region of the north of the country over the last two decades. The results are reported herein.…”

Section: Introductionmentioning

confidence: 99%

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

Bucchi

Mancini

Zamagni

et al. 2022

Acad Dermatol Venereol

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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.

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“…Based on the findings of Zamagni et al ., 1 one might raise the question of whether there is a place for costly melanoma screening programmes in order to find early‐phase thin melanomas and, consequently, to reduce mortality 4 . However, the investigators also report that the decrease in tumour thickness among male patients explains largely the survival improvement in patients diagnosed in 2008–2012 compared with those in 2003–2007, but not with those in 2013–2017 1 . In addition, in the German melanoma screening programme (SCREEN) in Schleswig‐Holstein in 2003–2004, total body examination in 360 288 individuals led to an almost 50% reduction in mortality as reported in 2012 9 .…”

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confidence: 99%

“…In this issue of the BJD , Zamagni et al 1 . present their findings of an increase in net survival from cutaneous malignant melanoma (CMM) in Italy (2003–2017).…”

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confidence: 99%

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Survival from cutaneous malignant melanoma is improving, but is it because of a trend in decreasing melanoma thickness or the advent of new ‘revolutionary’ therapeutics?

Harvima

2022

Br J Dermatol

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The relative contribution of the decreasing trend in tumour thickness to the 2010s increase in net survival from cutaneous malignant melanoma in Italy: a population‐based investigation*

Cited by 14 publications

References 59 publications

Dermoscopy Use Leads to Earlier Cutaneous Melanoma Diagnosis in Terms of Invasiveness and Size? A Single-Center, Retrospective Experience

Dermoscopy Use Leads to Earlier Cutaneous Melanoma Diagnosis in Terms of Invasiveness and Size? A Single-Center, Retrospective Experience

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

Survival from cutaneous malignant melanoma is improving, but is it because of a trend in decreasing melanoma thickness or the advent of new ‘revolutionary’ therapeutics?

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