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

The incidence of cutaneous malignant melanoma (CMM) has been rising in fair-skinned populations throughout the world for decades. The upward trend may, however, finally be slowing in some of these populations. Recent (1983-1996) CMM incidence trends for a high incidence area (New South Wales, Australia) have been examined according to gender, age group, body site and tumour thickness. Despite continuing upward trends in older age groups, particularly among men (e.g., 7.20% increase per year in men aged 75+), incidence for younger ages is stabilizing (in men) or declining (in women): average annual percentage changes of -3.03 and -0.88 were observed for women aged 15-34 and 35-54, respectively. Patterns suggest a birth-cohort effect, with those born since 1945 or 1950 having lower (females) or similar (males) rates to those born earlier. For each gender, all-ages incidence rose by a similar amount for each of the main body sites except the leg in women, where incidence fell by 0.49% per year. In men, the incidence of both thin (75 mm) melanomas increased (significantly, by 2.63% per year and non-significantly, by 0.93% per year, respectively) between 1989 and 1996. In women, incidence remained stable for both thickness subgroups. These data are consistent with a stabilization or reduction in either total sun exposure or intermittency of exposure among New South Wales cohorts born since about 1950. Because incidence rates are still much higher than they were a few decades ago, however, efforts to reduce sun exposure, particularly in children and youth, must continue.     

Recent cohort trends in malignant melanoma by anatomic site in the United States

The incidence of malignant melanoma has been increasing steadily in the United States. The increase may be due to lifestyle changes in subsequent generations or birth cohorts. The nine population-based tumor registries in the Surveillance, Epidemiology, and End Results program (SEER) have been in existence for a sufficient time to begin to investigate cohort trends for the US population. Cases were the 18.787 Caucasians aged 20 to 84 years, who reported to SEER registries with a diagnosis of melanoma in 1974–86. Among men born between 1890 and 1919, each subsequent five-year birth cohort experienced 45 to 57 percent increases in age-adjusted melanoma incidence of the arm and trunk, and 14 to 20 percent increases were experienced across each site (arm, leg, head, and trunk) for the 1920–44 cohorts of men. Among women born between 1890 and 1919, 24 to 29 percent increases were seen for melanoma of the trunk, arms, and legs for each subsequent five-year birth-cohort, followed by six to 29 percent increases in the 1920–44 cohorts. Recent birth cohorts, 1945–64, have shown stabilizing rates, even after an attempt to adjust for the increasing tendency for diagnoses to be made in doctors' offices. Thus, the dramatic birth-cohort effects appear to have ended beginning with those born in 1945. However, melanoma rates will continue to rise until those born after 1945 represent the majority of the population. Furthermore, for the most recent cohorts, the trunk has become the most common site (per square meter of body surface) for men and the second most common site for women. This suggests that some lifestyle change has led to more damaging exposure (e.g., sunburns) of the trunk among recent cohorts than earlier cohorts.Authors are with Fred Hutchinson Cancer Research Center, Seattle, WA, and the Department of Epidemiology at the School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA. Address correspondence to Dr Dennis, Fred Hutchinson Cancer Research Center, 1124 Columbia Street, MP702, Seattle, WA98104, USA. This research was supported by grant CA 34847 from the US National Cancer Institute.     

Malignant melanoma incidence in Connecticut (United States): time trends and age-period-cohort modeling by anatomic site

This study examined time trends and age-period-cohort patterns in the incidence of cutaneous malignant melanoma (CMM) by gender and anatomic site in Connecticut (United States) between 1950 and 1989, using data from the population-based Connecticut Tumor Registry. A total of 8,249 invasive CMM incident cases were included. Cases were grouped into melanomas of the head and neck, upper limb, lower limb, and trunk. Between 1950 and 1989, rates increased substantially for all sites. The largest relative increases occurred in melanoma of the upper limb for both males and females; the largest absolute increase occurred for melanoma of the trunk in males; and the smallest increase occurred in head and neck melanoma in females. Recent trends for time periods 1970–89 among birth cohorts 1930–69 indicated that the rate of increase of CMM is slowing substantially among males, but not among females. Nevertheless, continued overall increases in CMM incidence are likely in Connecticut in the 1990s in both genders, with a decrease in the male-female ratio. The age-period-cohort patterns were significantly different between the genders and among anatomic sites, suggesting different trends in carcinogenic exposures (mainly ultraviolet radiation from the sun) or etiologic distinctions between males and females and among the sites.This study was supported by the National Institute of Health grant # CA-62986, and #CA-30931. Dr Dubrow received support from a National Cancer Institute Preventive Oncology Academic Award (K07-CA01463).     

Proportional melanoma incidence and occupation among White males in Los Angeles County (California,United States)

A case-control analysis of cancer registry data was used to examine the hypothesis that occupational exposure to sunlight influences the risk of melanoma. Occupation at diagnosis was available for 3,527 cutaneous melanomas and 53,129 other cancers identified by the Los Angeles County (California, United States) Cancer Surveillance Program among non-Spanish-surnamed White males aged 20 to 65 years between 1972 and 1990. Occupational exposure to sunlight was assessed by blinded expert coding of job titles as indoor, outdoor, and mixed indoor/outdoor. Relative to indoor occupations, proportionate odds ratios (OR) adjusted for age, level of education, and birthplace were 1.16 (95 percent confidence interval [CI]=1.07–1.27) for indoor/outdoor occupations and 1.15 (CI=0.94–1.40) for outdoor occupations. However, increasing levels of the education or training required for the occupation was associated more strongly with increased melanoma occurrence (ORs adjusted for age, occupational sun exposure, and birthplace, were 1.0, 1.63, 2.09, 2.23, and 2.99 for low-skill occupation, high school, college, postgraduate, and doctoral levels, respectively). Analysis of melanoma occurrence by job titles confirmed a clear variation by the required education or training level but not by the category of occupational sunlight exposure. The findings suggest that lifestyle factors associated with higher levels of education may be more important determinants of melanoma risk than characteristics of the work environment.where Drs London and Mack continue their affiliation. This activity has been supported in part by the California Department of Health Services as part of its statewide cancer reporting program, mandated by Health and Safety Code Section 210 and 211.3. The ideas and opinions expressed herein are those of the authors, and no endorsement of the State of California, Department of Health Services or the California Public Health Foundation is intended or should be inferred. Contract number N01-CN-25403 of the Division of Cancer Prevention and Control, National Cancer Institute, National Institutes of Health, Department of Health and Human Services provided further support for this research.     

Oral contraceptive use and risk of cutaneous malignant melanoma

The relation between cutaneous malignant melanoma (MM) and the use of oral contraceptives (OC) was investigated in a case-control study carried out from 1979 to 1991 among patients in hospitals and clinics in the Philadelphia (PA) and New York City (NY) metropolitan areas (United States). Cases were 615 women under age 70 who recently had been diagnosed with invasive melanoma; controls were 2,107 women of the same ages who had been treated for other conditions unrelated either to OC use or to skin diseases. The cases were categorized as severe or nonsevere based on the depth of invasion of the tumor or the presence or absence of metastases. Among the severe cases, OC use was not associated with MM: the relative risk (RR) estimate for ever-use was 1.1 (95 percent confidence interval [CI]=0.8–1.5) and the estimate for 10 or more years of use was 1.1 (CI=0.6–2.1). Nor was risk associated with recent use, long latency, or young age at first use. Among the nonsevere cases, ever-use of oral contraceptives was associated positively with MM (RR=1.5, CI=1.1–2.4) but there was no trend with increased duration of use. The findings provide evidence against the hypothesis that OC use increases the risk of malignant melanoma. The elevated estimates among the nonsevere cases most likely reflect selection bias rather than a causal relation.This research was supported in part by the US National Cancer Institute (grant R01 CA 45762). Additional support was provided by the US Food and Drug Administration (FD-U-000082); the views expressed do not necessarily represent the views of the Food and Drug Administration. The Slone Epidemiology Unit receives general support from Hoffmann-LaRoche, Inc. and Marion-Merrell Dow, Inc.     

Cutaneous melanoma at Lawrence Livermore National Laboratory: comparison with rates in two San Francisco Bay Area counties

During the period 1974 through 1985, employees at Lawrence Livermore National Laboratory (LLNL), Livermore, CA (United States) were diagnosed with cutaneous malignant melanoma at approximately three times the rate of the surrounding community. We investigated two explanations for this excess: the first explanation examined was that the recorded incidence of the neighboring community underestimates actual incidence. We estimated the amount of excess attributable to underreporting by using data from a survey conducted among San Francisco Bay Area clinicians and pathologists to determine previously unrecorded occurrences. We found that underreporting has negligible impact on melanoma incidence. The second explanation examined was that heightened medical awareness of the disease among LLNL employees and their physicians has led to greater detection. We found that LLNL melanomas are thinner than those from the surrounding community and that no excess was observed if we limited our attention to thicker, more invasive melanomas.The research of Drs Gong and Whittemore was supported in part by NIH grant CA 47448.     

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

BACKGROUND: It is not yet clear whether increasing melanoma incidence is real or whether recent incidence trends mainly reflect improved diagnosis. To address this question, we examined the most recent melanoma incidence patterns among the white population stratified by sex, age, tumor stage, and tumor thickness by use of data from the Surveillance, Epidemiology, and End Results Program. METHODS: We examined log-transformed age-specific rates for melanoma by 5-year age groups and time periods by year of diagnosis and birth cohort. Melanoma trends were further examined among broader age groups (<40 years, 40-59 years, and > or =60 years) by tumor stage and tumor thickness. Rates were age-adjusted to the 1970 U.S. standard population, and trends were tested by use of a two-sided Student's t test. RESULTS: Melanoma incidence increased in females born since the 1960s. From 1974-1975 through 1988-1989, upward trends for the incidence of localized tumors and downward trends for the incidence of distant-stage tumors occurred in the age group under 40 years. In the more recent time period, 1990-1991 through 1996-1997, age specific rates among females compared with males generally remained stable or declined more for distant-stage tumors and increased less for local-stage tumors. Thin tumors (<1 mm) increased statistically significantly in all age groups (P<.05 for all), except in men under age 40 years. In contrast, rates for thick tumors (> or =4 mm) increased statistically significantly (P =.0003) only in males aged 60 years and older. CONCLUSION: Melanoma incidence may well continue to rise in the United States, at least until the majority of the current population in the middle-age groups becomes the oldest population. The recent trends may reflect increased sunlight exposure.     

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

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 (< 1.5 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.     

Up-to-date survival estimates and historical trends of cutaneous malignant melanoma in the south-east of The Netherlands.

BACKGROUND: We present survival outcomes of patients registered in the Dutch population-based Eindhoven Cancer Registry (ECR). PATIENTS AND METHODS: Data on patients diagnosed with a melanoma between 1980 and 2002 were obtained from the ECR. Data on vital status up to 1 January 2005 were obtained, up-to-date survival rates were calculated using period analysis. Multivariate analyses were carried out using Cox proportional hazards model. RESULTS: Ten-year crude survival rates were 82% for women and 60% for men (P < 0.05). Thin melanomas (Breslow thickness 74%, for melanomas >4.0 mm these rates were <65% (P < 0.05). In the early 1980s, 5-year relative survival rates were 84% and 62% for young (<60 years) women and men, and 66% and 69%, respectively, for the elderly (aged 60+). In the period 2000-2002, these rates had improved to >90% for females and to >72% for males. Multivariate analyses showed increased hazard ratios with increasing age and Breslow thickness, being male, having a melanoma on the trunk or unknown sites and having a nodular melanoma. CONCLUSIONS: Despite the absence of improvements in treatment options for melanoma, survival improved significantly, except for elderly males.     

Significance of 99mTc-sulfur colloid splenic image in malignant melanoma

To evaluate the clinical significance of ^99mTc-sulfur-colloid (TcSC) spleen scan findings in patients with malignant melanoma, a retrospective study was undertaken. Eighty-one patients with histologically proven malignant melanoma who received treatment in Roswell Park during a five-year period were included in this study. The scans were analyzed for spleen size, differential uptake of the tracer in liver and spleen, and for the presence of metastases in these two organs. These data were compared with stage of disease, survival, and autopsy findings. Significant correlation was found between the splenic size as measured on the scintiscan and at autopsy examination. The spleen size was found to be normal in 92% of the patients in early melanoma. The median survival of patients who had a normal-sized spleen by scan criteria was found to be longer than those who had splenomegaly. No significant difference in survival was noted between the patients with and without augmented splenic uptake of TcSC. Only a small number (17.7%) of patients with augmented splenic uptake had splenic metastases; hence, the possible role of immunological factors was considered.     

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

We analyzed time trends in incidence of and mortality from malignant cutaneous melanoma in European populations since 1953. Data were extracted from the EUROCIM database of incidence data from 165 cancer registries. Mortality data were derived from the WHO database. During the 1990s, incidence rates were by far highest in northern and western Europe, whereas mortality was higher in males in eastern and southern Europe. Melanoma rates have been rising steadily, albeit with substantial geographic variation. In northern Europe, a deceleration in these trends occurred recently in persons aged under 70. Joinpoint analyses indicated that changes in these trends took place in the early 1980s. In western Europe, mortality rates have also recently leveled off [estimated annual percentage change (EAPC) from -13.6% (n.s.) to 3.3%], whereas in eastern and southern Europe both incidence and mortality rates are still increasing [incidence EAPCs 2.3-8.9%, mortality EAPCs -1.8% (n.s.) to 7.2%]. Models including the effects of age, period and birth cohort were required to adequately describe the rising incidence trends in most European populations, with a few exceptions. Time trends in mortality were adequately summarized on fitting either an age-cohort model (with the leveling off of rates starting in birth cohorts between 1930 and 1940) or an age-period-cohort model. The most plausible explanations for the deceleration or decline in the incidence and mortality trends in recent years in northern (and to a lesser extent western) Europe are earlier detection and more frequent excision of pigmented lesions and a growing public awareness of the dangers of excessive sunbathing.     

Colon cancer incidence: recent trends in the United States

Between 1976–78 and 1985–87, the age-adjusted incidence rates of invasive colon cancer in the United States rose by 15 percent, 3 percent, 21 percent, and 16 percent among White males, White females, Black males, and Black females, respectively. The increases in incidence occurred in all age groups over age 54 and affected each of the major subsites of the colon nearly equally. The larger rates of increase have resulted in higher incidence among Blacks than Whites by the mid-1980s and an increasingly greater excess of this cancer in males. Trends toward earlier diagnosis of invasive colon cancer were found, with increasing rates for localized and regional diseases coupled with stable or decreasing distant-stage disease-rates. The incidence ofin situ colon cancer also rose substantially. The findings suggest that changes in diagnostic trends and risk-factor prevalence may be contributing to these patterns, and that the era when colon cancer predominated among White females is clearly over.Authors are with the Epidemiology and Biostatistics Program, Division of Cancer Etiology, National Cancer Institute, National Institutes of Health. Address correspondence to Dr Chow, National Cancer Institute, 6130 Executive Blvd, EPN Room 407, Rockville, MD 20892, USA.     

Management of cutaneous melanoma M0: state of the art and trends

This article reviews the epidemiology, diagnosis and treatment of cutaneous melanoma, including the most recent developments. The combination of positive family history, fair complexion, number of nevi, exposure to sun and/or chromosomal alterations seem to be implicated in the pathogenesis of cutaneous melanoma. Melanomas can be classified according to their growth patterns, and tumour microstaging is of straightforward predictive value for survival and risk of metastasis, although new factors are also being investigated. As yet, surgical excision is the only effective treatment available for primary tumours, resection margins varying according to tumour thickness. Elective node dissection is, however, no longer advocated for melanomas thinner than 1.5 mm, and there is disagreement as to its role for thicker lesions. In contrast, selective node dissection at the time of definitive surgery is becoming more widely accepted, with regional node dissection being restricted to positive cases. Therapeutic dissection is required for lymph node involvement, the most common pattern of recurrence from melanoma, which affects nearly 30% of all patients. Complete remission rates from isolated limb perfusion, which has been employed in patients with multiple recurrences or in-transit metastases, range from 40 to 90%, depending on drugs and techniques used in different series; the best responses so far have been obtained with tumour necrosis factor in combination with melphalan. Patients with thick lesions (> 4 mm) or lymph node metastases have a high risk of micrometastases that would warrant adjuvant therapy. The only agent found to affect survival is interferon alpha-2.     

Latitude gradients in melanoma incidence and mortality in the non-Maori population of New Zealand

The variation with latitude of incidence and mortality for cutaneous malignant melanoma (CMM) in the non-Maori population of New Zealand was assessed. For those aged 20 to 74 yeas, the effects of age, time period, birth-cohort, gender, and region (latitude), and some interactions between them were evaluated by loglinear regression methods. Increasing age-standardized incidence and mortality rates with increasing proximity to the equator were found for men and women. These latitude gradients were greater for males than females. The relative risk of melanoma in the most southern part of New Zealand (latitude 44° S) compared with the most northern region (latitude 36° S) was 0.63 (95 percent confidence interval [CI]=0.60–0.67) for incidence and 0.76 (CI=0.68–0.86) for mortality, both genders combined. The mean percentage change in CMM rates per degree of latitude for males was greater than those reported in other published studies. Differences between men and women in melanoma risk with latitude suggest that regional sun-behavior patterns or other risk factors may contribute to the latitude gradient observed.This work was carried out during the tenure(by J-L.B.) of a Training Scholarship from the Swiss League Against Cancer.     

Cutaneous melanoma mortality starting to change: A study of trends in Northern Ireland

Incidence and mortality of melanoma have increased among men and women in Europe. We analysed the incidence and mortality of cutaneous melanoma (CM) in Northern Ireland. Three thousand eight hundred and thirty-seven incident cases of CM were reported to the Northern Ireland Cancer Registry (NICR) from 1984 to 2006 and 1177 melanoma deaths occurred from 1955 to 2007. Trends were analysed using joinpoint regression and a negative binomial model was fitted to test the linear trends for incidence adjusted for calendar year, age, sex and Breslow thickness. Age-adjusted incidence rates of CM increased significantly in both men and women (estimated annual percent change (EAPC): 4.8% and 2.5%, respectively). The increase was essentially due to thin melanoma (<1 mm). In contrast, there was a stabilisation of incidence of thick melanomas (4 mm) in men and suggestion of a decrease in incidence of thick melanomas in women (EAPC: –1.5, 95% confidence interval (CI) –3.6;0.6). Mortality rates increased steadily in men over the whole period 1955–2004 (EAPC: 1.8%, 95% CI 1.1;2.5) whereas in women it increased until 1980 and decreased after (EAPC: –1.0%, 95% CI –2.5;0.6). We report for the first time a downward shift in all age mortality after steady increases but for women only. The plausibility of this shift is supported by similar downward trend in thick melanoma incidence in females only. Although there has been an active sun protection programme in Northern Ireland since 1990, the reason for the changes in female mortality which predates the programme remains to be fully understood.     

Worldwide trends in cervical cancer incidence: Impact of screening against changes in disease risk factors

BackgroundCervical cancer trends in a given country mainly depend on the existence of effective screening programmes and time changes in disease risk factors, notably exposure to human papillomavirus (HPV). Screening primarily influences variations by period of diagnosis, whereas changes in risk factors chiefly manifest themselves as variations in risk across successive birth cohorts of women.MethodsWe assessed trends in cervical cancer across 38 countries in five continents, age group 30–74 years, using age-standardised incidence rates (ASRs) and age-period-cohort (APC) models. Non-identifiability in APC models was circumvented by making assumptions based on a consistent relationship between age and cervical cancer incidence (i.e. approximately constant rates after age 45 years).FindingsASRs decreased in several countries, except in most of Eastern European populations, Thailand as well as Uganda, although the direction and magnitude of period and birth cohort effects varied substantially. Strong downward trends in cervical cancer risk by period were found in the highest-income countries, whereas no clear changes by period were found in lower-resourced settings. Successive generations of women born after 1940 or 1950 exhibited either an increase in risk of cervical cancer (in most European countries, Japan, China), no substantial changes (North America and Australia) or a decrease (Ecuador and India).InterpretationIn countries where effective screening has been in place for a long time the consequences of underlying increases in cohort-specific risk were largely avoided. In the absence of screening, cohort-led increases or, stable, cervical cancer ASRs were observed. Our study underscores the importance of strengthening screening efforts and augmenting existing cancer control efforts with HPV vaccination, notably in those countries where unfavourable cohort effects are continuing or emerging.FundingBill and Melinda Gates Foundation (BMGF).     

Altered expressions of HOX genes in human cutaneous malignant melanoma

HOX genes act as master genes to control morphogenesis. In human, HOX genes form 4 clusters composing 9 to 11 HOX genes (39 genes in total) on different chromosomes. We hypothesized that aberrant expression of HOX genes was associated with development and subsequent progression of melanoma and that the 39 HOX gene expression pattern determined the sites where melanoma grew. The expression levels of 39 HOX genes in 15 human cutaneous melanoma specimens and 7 nevus pigmentosus specimens were quantified by a comprehensive analysis system based on the real-time RT-PCR method. We found that the expression levels of HOXA11, A13, B9, D12 and D13 in melanoma were higher than those in nevus pigmentosus and that the expression levels of HOXA11, B2 and C13 were significantly different between pT4 melanoma and pT1 to pT3 melanoma. It was most notable that the expression levels of HOXA1, A2, C4 and B13 in melanoma with distant metastasis were higher than those in melanoma without it. On the other hand, we found no relationship between HOX genes expression patterns and the growing sites of melanoma. These results indicated that the misexpressions of some specific HOX genes were implicated in melanoma genesis and metastasis but had no linkage with melanoma sites.     

Relationship of uveal and cutaneous malignant melanoma in persons with multiple primary tumors

Uveal and cutaneous melanomas differ in tumor biology, immunophenotypes and the demographic correlates of their occurrence. As a means to examine the possibility of some shared etiologic factors, we wished to learn if the 2 cancers occurred in the same individual more often than would be expected by chance. Data from the Surveillance, Epidemiology and End Results (SEER) program from 1973-1998 were utilized for this purpose. The number of persons who went on to develop a second melanoma was compared to that expected based on the incidence of each type of melanoma in the general population, after adjusting for age, sex, calendar year and residence. Given an initial cutaneous melanoma, there was a 10-fold increased risk of developing a second cutaneous melanoma (95% confidence interval [CI] = 9.4-10.6). Persons with uveal melanoma went on to develop cutaneous melanoma 4.6 times (95% CI = 2.9-6.8) more often than the population at large. In contrast, persons with cutaneous melanoma were not subsequently diagnosed with uveal melanoma at an appreciably elevated rate (standardized incidence ratio [SIR] = 1.4; 95% CI = 0.5-3.0). While these data offer some support for the hypothesis that uveal and cutaneous melanomas have 1 or more etiologies in common, the lack of symmetry in the pattern of second uveal and second cutaneous melanomas remains unexplained.