Elsevier

Clinics in Dermatology

Volume 27, Issue 1, January–February 2009, Pages 3-9
Clinics in Dermatology

Melanoma epidemiology and trends

https://doi.org/10.1016/j.clindermatol.2008.09.001Get rights and content

Abstract

Rising incidence rates of cutaneous melanoma have been observed during the last four decades in white populations worldwide. The cancer statistics in the United States have revealed 6 cases per 100,000 and year at the beginning of the 1970s and 18 cases per 100,000 inhabitants and year at the beginning of 2000, demonstrating a threefold increase in incidence rates. Incidence rates in central Europe increased in the same time period from 3 to 4 cases to 10 to 15 cases per 100,000 inhabitants and year, which is very similar to the increase in the United States. Cohort studies from several countries indicate that the trend of increasing incidence rates will continue in the future for at least the next 2 decades; thus, an additional doubling of incidence rates is expected. The highest incidence rates have been reported from Australia and New Zealand, from 40 to 60 cases per 100,000 inhabitants and year. Mortality rates likewise slightly increased in the United States and in Europe during the 1970s and 1980s. In the 1990s, however, a leveling off of mortality rates was observed in many countries. Simultaneously, a clear decrease of Breslow tumor thickness was reported in the United States and European countries. This development indicates improved early recognition of cutaneous melanoma, which is presently the main factor for a more favorable prognosis.

Introduction

During the last decades, cutaneous melanoma (CM) has shown increasing incidence rates and has developed from a very rare disease entity into a cancer with growing importance medically.1 Cutaneous melanoma is a skin cancer nearly exclusively occurring in white populations, whereas its incidence remains very in low populations of African or Asian origin with darker pigmentation. Increasing incidences were mainly reported from industrial countries with white populations, with the highest incidence rates in Australia and the southern states of the United States.2 Incidence rates in the European countries are still lower but likewise showed threefold to fivefold increases during the last decades.3 This increase of melanoma incidence is related to changing attitudes of leisure time behavior and of sun exposure. This contribution focuses on recent developments of melanoma epidemiology in white populations worldwide.

Section snippets

Increase of melanoma incidence in white populations

A continuous increase of CM incidence rates has been observed during the last 4 decades in many countries with white populations.4 The annual increase of CM incidence varies between populations but has been estimated at between 3% and 7%.5, 6, 7, 8, 9 These estimates suggest a doubling of rates every 10 to 20 years. Cutaneous malignant melanoma is the most rapidly increasing cancer in white populations. The cancer statistic in the United States was reported to be 6 cases per 100,000 inhabitants

Leveling off of mortality rates

Mortality rates from CM were increasing until the 1980s in the populations of most European countries21, 22 as well as in the populations of North America, Australia, and New Zealand.10, 23, 24, 25 Mortality rates peaked in 1988 to 1990 and thereafter have been less uniform. Mortality rates are still rising in several European countries for middle-aged adults but with more favorable trends among women; some leveling-off in rates has occurred for young adults and have remained roughly constant

Clinical epidemiology

Analyses for the clinical aspects of melanoma epidemiology are mainly based on large clinical databases that contain follow-up information of melanoma patients and are appropriate for survival analysis.30, 31, 32, 33 In Germany, the Central Malignant Melanoma Registry (CMMR) is such a database, which has registered more than 70,000 cases with CM.34, 35, 36 This article presents some of the data to illustrate the clinical epidemiology of melanoma.

Sex and age

The male/female ratio varies in melanoma databases in different countries. In countries with a high CM incidence, such as Australia and the United States, a preponderance of men is observed.4, 5, 15, 37 In countries with a lower incidence, such as Great Britain, a higher ratio of women patients with melanoma can be found.38 In Germany in the time of low incidence rates in the 1970s, almost two-thirds of CM patients were women; whereas in the 1990s, the ratio of both sexes equalized.34

In

Anatomic site

The anatomic site varies according to sex. In men, 55% of the tumors are localized on the trunk, with 39% on the back; in women, 42% are localized on the lower extremity, with 24% on the lower leg, followed by 25% on the trunk (Table 1). CM localized on the head and neck region and the upper extremity follow and are nearly equivalent in both sexes.34, 36 A very similar site distribution was found in most industrial nations with inhabitants of white origin such as in Europe, the United States,

Histopathologic subtype

Superficial spreading melanoma is the most frequent histopathologic CM subtype, composing nearly 59% of all CM, followed by nodular melanoma at 21%, lentigo-maligna melanoma at 11%, and acrolentiginous melanoma at 4% (Table 2). A similar distribution is found in the analyses of incidence rates in the United States and Canada.5, 12

Different age distributions are found for the respective histopathologic subtypes. The peak age is 54 years old for superficial spreading melanomas, 59 years old for

Tumor thickness

The tumor thickness is the most important prognostic factor in primary melanoma.30, 35, 44, 45 In this respect tumor thickness is the most important criterion for analyzing the development of early detection of melanoma.46, 47

An ongoing trend for diagnosis of melanoma with thinner tumor thickness has been shown for a number of countries.27, 29, 48, 49 In Germany a trend towards diagnosing thin melanoma has been reported since the 1980s.34, 50, 51 The median tumor thickness decreased from 1.81

Sun exposure and melanoma

To date, it is widely accepted that a person's total risk of melanoma is determined through the interplay between genetic factors and exposure to sunlight.53 Eighty percent of melanomas develop in regions that receive intermittent sun exposure. Intermittent sun exposure and sunburn history have been identified as risk factors for melanoma in epidemiologic studies.54, 55

The role of sunlight in melanoma development has been a matter of debate for decades because the effect of sunlight in the

Trends in melanoma epidemiology

In most countries with white populations, an ongoing trend of increasing incidence for CM still continues. Cohort studies in Europe do not yet indicate a leveling of incidence rates, and expectations are that this trend will continue for at least the next 2 or 3 decades and that the melanoma incidence will further double during this period.78, 79 Similarly, age-cohort analyses of CM incidence revealed that incidence rates may well continue to rise in the United States.1 In contrast to the

References (81)

  • YazdiA.S. et al.

    Mutations of the BRAF gene in benign and malignant melanocytic lesions

    J Invest Dermatol

    (2003)
  • JemalA. et al.

    Recent trends in cutaneous melanoma incidence among whites in the United States

    J Natl Cancer Inst

    (2001)
  • GarbeC. et al.

    Epidemiology of cutaneous melanoma in Germany and worldwide

    Skin Pharmacol Appl Skin Physiol

    (2001)
  • MarksR.

    Epidemiology of melanoma

    Clin Exp Dermatol

    (2000)
  • GellerA.C. et al.

    Melanoma incidence and mortality among US whites, 1969–1999

    JAMA

    (2002)
  • Globocan 2000
    (2001)
  • MackieR.M. et al.

    Cutaneous malignant melanoma in Scotland: incidence, survival, and mortality, 1979–94. The Scottish Melanoma Group

    BMJ

    (1997)
  • Mansson-BrahmeE. et al.

    Trends in incidence of cutaneous malignant melanoma in a Swedish population 1976–1994

    Acta Oncol

    (2003)
  • de VriesE. et al.

    Changing epidemiology of malignant cutaneous melanoma in Europe 1953–1997: rising trends in incidence and mortality but recent stabilizations in western Europe and decreases in Scandinavia

    Int J Cancer

    (2003)
  • Anonymus

    Stat bite: incidence of and mortality from melanoma of the skin, 1975–2000

    J Natl Cancer Inst

    (2003)
  • Robert Koch-Institut

    Cancer in Germany 2003–2004. Frequencies and trends

    (2008)
  • BulliardJ.L. et al.

    Trends by anatomic site in the incidence of cutaneous malignant melanoma in Canada, 1969–93

    Cancer Causes Control

    (1999)
  • DennisL.K.

    Analysis of the melanoma epidemic, both apparent and real: data from the 1973 through 1994 surveillance, epidemiology, and end results program registry

    Arch Dermatol

    (1999)
  • MarrettL.D. et al.

    Trends in the incidence of cutaneous malignant melanoma in New South Wales, 1983–1996

    Int J Cancer

    (2001)
  • OsterlindA. et al.

    Incidence of cutaneous malignant melanoma in Denmark 1978–1982. Anatomic site distribution, histologic types, and comparison with non-melanoma skin cancer

    Br J Cancer

    (1988)
  • BalziD. et al.

    Cutaneous melanoma in the Florentine area, Italy: incidence, survival and mortality between 1985 and 1994

    Eur J Cancer Prev

    (2003)
  • Ocana-RiolaR. et al.

    Population-based study of cutaneous malignant melanoma in the Granada province (Spain), 1985–1992

    Eur J Epidemiol

    (2002)
  • MacLennanR. et al.

    Increasing incidence of cutaneous melanoma in Queensland, Australia

    J Natl Cancer Inst

    (1992)
  • JonesW.O. et al.

    Incidence of malignant melanoma in Auckland, New Zealand: highest rates in the world

    World J Surg

    (1999)
  • BalziD. et al.

    Malignant melanoma in Europe: changes in mortality rates (1970–90) in European Community countries

    Cancer Causes Control

    (1997)
  • StangA. et al.

    Skin melanoma in Saarland: incidence, survival and mortality 1970–1996

    Eur J Cancer Prev

    (2001)
  • BulliardJ.L. et al.

    Cutaneous malignant melanoma in New Zealand: trends by anatomical site, 1969–1993

    Int J Epidemiol

    (2000)
  • InsingaR.P. et al.

    Trends in malignant melanoma incidence and mortality in Wisconsin, 1979–1997

    WMJ

    (1902)
  • GaudetteL.A. et al.

    Cancer incidence and mortality across Canada

    Health Rep

    (1998)
  • BosettiC. et al.

    Mortality from cutaneous malignant melanoma in Europe. Has the epidemic levelled off?

    Melanoma Res

    (2004)
  • CrocettiE. et al.

    Changes from mid-1980s to late 1990s among clinical and demographic correlates of melanoma thickness

    Eur J Dermatol

    (2003)
  • van der Spek-KeijserL.M. et al.

    Site, histological type, and thickness of primary cutaneous malignant melanoma in western Netherlands since 1980

    Br J Dermatol

    (1997)
  • GarbeC. et al.

    Time trends of cutaneous melanoma in Queensland, Australia and Central Europe

    Cancer

    (2000)
  • BalchC.M. et al.

    Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system

    J Clin Oncol

    (2001)
  • BalchC.M. et al.

    A new American Joint Committee on Cancer staging system for cutaneous melanoma

    Cancer

    (2000)
  • Cited by (517)

    View all citing articles on Scopus
    View full text