Original article
Epidemiological changes in cutaneous melanoma: Retrospective study of 969 cases (1996–2010)Cambios epidemiológicos en el melanoma cutáneo: estudio retrospectivo de 969 casos (1996–2010)

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Abstract

Background

The incidence of malignant melanoma has increased over recent decades all over the world; however, we are not aware if this also occurs in Madrid. Our objective was to analyze epidemiological changes in cutaneous malignant melanomas diagnosed over a 15-year period.

Patients and methods

Retrospective analysis of data of patients with primary cutaneous melanomas attended at Hospital Gregorio Marañón, Madrid, Spain, between 1996 and 2010, divided into three periods: 1996–2000; 2001–2005; 2006–2010, was obtained.

Results

In total, 969 melanomas were histologically diagnosed. The mean age at the moment of diagnosis was 58.5 years old. The mean tumor thickness was 1.61 mm. The most common histological type was surface-spreading melanoma and the most common site was the trunk. There were statistically significant differences (P < .05) between the three periods of the study: older age at diagnoses (P < .001); larger number of head and neck melanomas (P < .001); more melanomas on trunk in women (P < .001); increase of lentigo maligna melanoma (P < .001); thinner mean tumor thickness (Breslow index) (P < .001); larger number of melanomas in situ (P < .001). However, thick melanomas (tumor thickness over 2 mm) ratio was still over 20% in all periods, especially in males and in those over 65 years old.

Conclusions

Diagnosis of cutaneous melanoma in Spain is made increasingly with a thinner mean tumor thickness, although thick melanomas are still diagnosed in men and in individuals over 65 years.

Resumen

Introducción

La incidencia del melanoma cutáneo ha aumentando durante las últimas décadas en muchos países, pero desconocemos si esto también ha sucedido en Madrid. Hemos analizado los cambios epidemiológicos ocurridos en el melanoma cutáneo durante un período de 15 años.

Pacientes y métodos

Se obtuvieron de forma retrospectiva los datos referentes a todos los pacientes con melanoma cutáneo atendidos en el Hospital Gregorio Marañón de Madrid entre los años 1996-2010, dividido en 3 periodos: 1996-2000; 2001-2005, y 2006-2010.

Resultados

Se diagnosticaron histológicamente un total de 969 melanomas. La edad media en el momento del diagnóstico fue de 58,5 años. El espesor tumoral medio fue de 1,61 mm. El tipo histológico más frecuente fue el melanoma de extensión superficial. Las diferencias estadísticamente significativas (p < 0,05) entre los 3 periodos del estudio fueron: mayor edad media al diagnóstico (p < 0,001); mayor número de melanomas en cabeza y cuello (p < 0,001); mayor número de melanomas en tronco en el sexo femenino (p < 0,001); aumento del melanoma tipo lentigo maligno (p < 0,001); disminución del espesor medio (índice de Breslow) (p < 0,001); mayor número de melanomas intraepidérmicos (p < 0,001). Sin embargo, la proporción de melanomas gruesos (> 2 mm de Breslow) se mantuvo por encima del 20%, siendo más frecuente este subtipo de melanomas en varones y en mayores de 65 años.

Conclusiones

El melanoma cutáneo en España se diagnostica con un espesor tumoral medio cada vez más fino, aunque se siguen diagnosticando melanomas de gran espesor especialmente en varones y pacientes de más de 65 años.

Introduction

The incidence and mortality of cutaneous melanoma have increased in recent decades in numerous countries.1, 2 Melanoma affects individuals of all races and ethnic groups, although its incidence is closely linked to the color composition of the skin and varies according to the geographical area of residence. This cancer is responsible for more than 90% of deaths due to skin cancer.3, 4

The most important prognostic factor in these patients is still tumor thickness.5 The public campaigns aimed at encouraging the early diagnosis of melanoma appear to have led to an increase in the incidence of melanoma at the expense of a larger number of diagnoses of thin melanomas.6, 7 However, the proportion of patients with thick melanomas, which are associated with a poorer prognosis, has not declined.7, 8, 9

There is debate as to whether the increase in the incidence of melanoma is real or is due to the bias introduced by the greater number of melanomas diagnosed in early stages.10, 11, 12, 13, 14, 15, 16

There are several studies on the epidemiology of cutaneous melanoma in Spain, but very few analyze the epidemiological, clinical and histological characteristics of these patients and whether there are variations in the epidemiological profiles of patients with melanoma compared with previous decades.17, 18, 19, 20, 21, 22

We have conducted a descriptive epidemiological analysis of patients histologically diagnosed with cutaneous melanoma in healthcare area number 1 of the Autonomous Community of Madrid, assigned to the University General Hospital Gregorio Marañón (HGUGM) over a period of 15 years (1996–2010). We analyzed the changes noted in the epidemiological variables over the course of the study. To analyze the differences over the course of the study, the patients were divided into 3 groups according to the year of diagnosis (period 1: 1996–2000; period 2: 2001–2005, and period 3: 2006–2010).

Section snippets

Material and methods

We analyzed data on all patients diagnosed by a histopathology report of cutaneous melanoma, primary or metastatic, of unknown origin, during the period between January 1, 1996 and December 31, 2010. It was irrelevant whether the initial diagnosis was made in the healthcare area corresponding to this hospital center or outside it, but the patients were nevertheless treated at HGUGM for this reason. These data were obtained primarily in the melanoma area of the Department of Dermatology at HGUGM

Results

A total of 969 patients were included. The overall epidemiological characteristics of these patients and the analysis of the differences observed during the study periods are shown in Table 1.

The mean age at the time of the diagnosis increased significantly over the course of the study (period 1996–2000: 57 years; period 2006–2010: 62 years; P < .001).

The location of the melanoma varied during the study periods, both overall and adjusted for gender. In males, the most common location was the

Discussion

The results obtained in our study in terms of the epidemiological variations observed in the patients with melanoma agree with those of other studies conducted on patients in Spain,17, 18, 19, 20, 21, 22, Italy,23, 24, 25 Germany,26, 27 and the United States.28 In general, we can see an increase in the annual incidence of melanoma in all of these studies, especially at the expense of facially located lentigo maligna melanomas in elderly individuals.18, 26 We also see an increase in the age at

Conflicts of interest

The authors have no conflicts of interest to declare.

References (28)

  • C. Garbe et al.

    Melanoma epidemiology and trends

    Clin Dermatol

    (2009)
  • T.L. Diepgen et al.

    The epidemiology of skin cancer

    Br J Dermatol

    (2002)
  • C.M. Balch et al.

    Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma

    J Clin Oncol

    (2001)
  • C. Garbe et al.

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

    Cancer

    (2000)
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    Please cite this article as: Avilés-Izquierdo JA, et al. Cambios epidemiológicos en el melanoma cutáneo: estudio retrospectivo de 969 casos (1996–2010). Rev Clin Esp. 2013:213:81–7.

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