Increases in invasive melanoma in England, 1979-2006, by anatomical site

Background National melanoma incidence trends with details of anatomical site have not been previously described for England. Objectives To describe site‐specific trends in cutaneous melanoma for England as a whole during the last three decades. Methods Anonymized data, 1979–2006, were obtained from national cancer registrations of all patients in England up to age 89 years with incident primary invasive cutaneous melanomas (n = 124 055). Sex‐specific age‐standardized incidence rates and average annual percentage change in rates were calculated for each broad anatomical site. Results Overall incidence rates of cutaneous melanoma in England, 1979–2006, were 81 and 100 per million, in males and females, respectively. Site‐specific rates were consistently highest on the lower limbs in females followed by the trunk in males. Greatest annual increases occurred on the trunk in both sexes over 45 years (males 9·9%, females 6·8%), then upper limbs (males 8·7%, females 6·8%). Incidence trends in males relative to females varied little across sites apart from a more rapid rise in head/neck melanomas in males than in females after the 1980s. Conclusions Invasive melanoma rates continue to rise in England, particularly on the trunk and arms, and in males on the head/neck. The steeper increases in melanoma rates among males are consistent with their greater sun exposure and poorer compliance with sun protection measures than females.     

Trends during a half century in relative squamous cell carcinoma distribution by body site in the Swedish population: support for accumulated sun exposure as the main risk factor

There is a strong relationship between squamous cell carcinoma (SCC) and exposure to ultraviolet radiation in terms of accumulated exposure. In this study, data from the Swedish Cancer Registry are surveyed to discern a reflection of behavioral and societal changes in relative distribution of SCC by body site. Data for the time period 1960-2004, including a total of 66 221 cases (56 669 people) were analyzed by body site for age and gender cohorts. The age-standardized (European population) incidence per 100 000 of SCC in the year 2004 was 30.4 in males and 15.4 in females. In the year 1960, the corresponding incidences were 7.7 and 3.8; that is, SCC has become four times more frequent in Sweden for both sexes during this period. The standardized incidence of SCC increased on all body sites except eyelids (men and women) and ears (women). Head tumors dominated among patients aged 70 years or more and diagnosed 1960-1964. Among patients less than 70 years old at diagnosis in 2000-2004, tumors of the trunk and limbs dominated. A relative increase of tumors of the scalp and neck was observed in all age groups (men), and of tumors of the trunk and upper limbs in all age groups and both sexes except among patients aged more than 90 years of age. In contrast, a relative decrease of tumors on the face (including the ears) was seen in all age groups. The relative increase of SCC of the trunk and upper limbs is a plausible reflection of intentional tanning.     

Dermoscopic naevus patterns in people at high versus moderate/low melanoma risk in Queensland

Introduction: Dermoscopic understanding of naevus characteristics is essential baseline knowledge for identifying early malignant changes. Method: This cross‐sectional study includes 34 patients (56% female, mean age 48 years) at high risk of melanoma (personal or a first degree family member with history of melanoma) and 31 moderate/low melanoma risk volunteers (55% female, mean age 37 years) recruited at the Princess Alexandra Hospital, Brisbane, between October 2009 and March 2010. Participants received full body and individual dermoscopic imaging of clinically significant naevi (≥2 mm on the back of male/female and lower limbs of female and ≥5 mm at other body sites). Dermoscopic patterns of naevi were compared between people at high versus moderate/low melanoma risk according to age and body site. Results: In both high and moderate/low risk groups, globular naevi predominated on the head/neck and abdomen/chest, reticular and non‐specific naevi on the back, and non‐specific pattern on the upper and lower limbs. Non‐specific naevi were the most common in all age groups. In both risk groups, globular naevi were more frequent in the younger age bracket, and reticular naevi were more frequent in the older age bracket. Mixed naevus patterns were infrequent and were more common in the younger age brackets of both risk groups. Conclusion: Our preliminary data shows that dermoscopic naevus patterns were similar for age and body site in people at different levels of melanoma risk, suggesting high melanoma risk does not influence dermoscopic naevus patterns.     

Does relative melanoma distribution by body site 1960-2004 reflect changes in intermittent exposure and intentional tanning in the Swedish population?

Intermittent exposure to UV-radiation at an early age is a known important factor in the aetiology of malignant melanoma. We surveyed data from the Swedish Cancer Registry for melanoma by body site for age and gender cohorts from 1960 to 2004, in an attempt to discern a reflection of major behavioural and societal changes in the relative distribution of melanoma by body site. The study comprised patients with malignant melanoma from the Swedish Cancer Registry, including information on body site of tumour (January 1, 1960 - December 31, 2004). In total, 46,337 malignant melanomas were diagnosed in 44,623 patients. Trends were assessed by incidence per site, and relative site distribution per age group and calendar period, and dividing body sites by exposure type to the sun: head (mostly continuous), trunk (mostly intermittent), and limbs (mixed exposure). Between calendar periods 1960-1964 and 2000-2004 melanomas increased most rapidly on the upper limbs (men 885%, women 1216%) on the trunk (men 729%, women 759%) and on the lower limbs (men 418%, women 289%) in both genders. The incidence increase of head tumors was slower. Across the life span, melanomas of the trunk and lower limbs dominate among patients < 70 years, whereas tumors of the head are most common among patients >or= 70 years. Tumors of the trunk formed an increasing proportion of all melanomas during the period studied, particularly in females. The relative shift of melanomas from the head to the trunk with mostly intermittent UV exposure coincides with behavioral and societal changes with regard to sun exposure. This supports the hypothesis of a relationship between intentional exposure to ultraviolet radiation and malignant melanoma.     

Anatomic distribution of acquired melanocytic nevi in white children. A comparison with melanoma: the Vancouver Mole Study

The presence of acquired benign nevi is a risk factor for cutaneous melanoma, yet relatively little is known about the etiology of nevi. We have conducted a study of the prevalence of melanocytic nevi among 1146 white Vancouver (Canada) schoolchildren aged 6 to 18 years. Numbers of nevi per square meter of body surface area increase with age in children of both sexes. Male adolescents have more nevi than female adolescents on the head and neck as well as on the trunk, while prevalence in females is higher on the upper and lower limbs. This distribution parallels that of cutaneous melanoma in British Columbia adults. Nevi are more common in children on intermittently exposed body sites than on constantly or minimally sun-exposed sites. This suggests that exposure to strong intermittent sunlight in childhood (a risk factor for cutaneous melanoma) may also be important in the etiology of acquired benign nevi.     

Does deprivation of area of residence influence the incidence,tumour site or T stage of cutaneous malignant melanoma? A population‐based and clinical database study

This study aimed to document the incidence of malignant melanoma at specific subsites in men and women, stratified by deprivation of area of residence in southeast England, and to explore the association between deprivation and tumour thickness at diagnosis. Data were extracted on 6468 cases from the Thames Cancer Registry for the years 1998 to 2002, and data on, and 508 cases were extracted from the clinical database of the Skin Tumour Unit, St Thomas' Hospital, for the years 1996 to 2004. The postcode of residence was used to assign quintiles of deprivation based on the income domain stated in the Indices of Deprivation 2000. For both males and females, the incidence was higher for those living in the most affluent areas. The trunk was the most common site in males and the lower limbs in females. All sites showed an affluence gradient, although this was least pronounced for head and neck tumours. Distribution of T stage at diagnosis did not differ by deprivation of area of residence.     

Melanoma of the scalp: an underdiagnosed malignancy?

We report a case of scalp melanoma that was found incidentally after the patient complained of pruritic lesions on his scalp. The melanoma was 13 mm in diameter and had a Breslow thickness of 0.25 mm. The incidence of melanoma has been on the rise, with a high incidence occurring in men on the head, neck, and trunk. This case stresses the need to thoroughly examine the entire scalp when performing total body screening examinations for skin cancer.     

Skin cancer trends in northern Jordan

Background The Jordan Cancer Registry was established in 1996, since which time all cases of cancer have been reported and registered. We have used this registry to perform the first analysis of skin cancer in northern Jordan and to compare our findings with those of published reports from other regions. Methods All histopathologically proven cases of skin cancer, reported during the years 1997 through 2001, were reviewed. Information regarding tumor type, age, gender, and anatomical location was collected. Results A total of 272 cases of malignant skin tumors were diagnosed between the years 1997 and 2001. Basal cell carcinoma (BCC) was the commonest type, representing 52.9% of all skin cancers. Females were more frequently affected than males, with age‐adjusted incidence rates of 23.3 and 19.7 per 100,000 of population, respectively. Squamous cell carcinoma (SCC) comprised 26.4% of the total, its age‐adjusted incidence rate per 100,000 of population being 14.2 for males and 6.18 for females. the incidence rate increased in males and decreased in females during the study period. The incidence of both BCC and SCC increased with age. The head and neck region was the commonest site affected by both types of cancer. Malignant melanoma (MM) comprised 11.39% of all skin cancer cases, with a female to male ratio of 1.2 : 1. The median age at onset for female patients was 49 years while that for males was 70 years, and the commonest site affected was the lower limbs, followed by the trunk. Conclusions In Jordan, sun‐related skin cancers have relatively low incidences and a rather stable pattern, compared with other areas with similar climate and skin phenotypes.     

Extrafacial lentigo maligna melanoma: analysis of 71 cases and comparison with lentigo maligna melanoma of the head and neck

We report a retrospective analysis of extrafacial lentigo maligna melanoma (LMM), and a comparison with patients with LMM of the head and neck. Seventy-one patients (22 men, 49 women) with extrafacial LMM were identified from the Scottish Melanoma Group database for January 1979–March 1996. Their mean age (63 years) was significantly less than that of 335 patients with head and neck LMM (mean 72 years, P < 0.001), with a significantly greater difference among women than men. Extrafacial sites comprised 17.5% of LMMs. There was a marked body site distribution difference between the sexes (P = 0.001): 68% of extrafacial LMMs in men were on the trunk while 80% in women were on the limbs, particularly the lower leg. Extrafacial LMMs were thinner at presentation than head and neck LMMs (P < 0.05) in both sexes, but this was not simply explained by the younger age of these patients as there was no significant correlation between age and tumour thickness at either extrafacial or at head and neck sites. Although the female lower leg is a site of chronic solar exposure in older women, the other extrafacial sites are habitually covered in the temperate Scottish climate. The significantly younger age group of patients with LMM at extrafacial compared with head and neck sites therefore suggests that the relationship between LMM and sunlight is not simply related to cumulative solar exposure. The demonstration that head and neck LMMs were thicker at presentation compared with extrafacial sites, despite being at a more routinely visible part of the body, suggests that there are still opportunities for targeted pigmented lesion public education.     

The Eastern Australian Childhood Nevus Study: site differences in density and size of melanocytic nevi in relation to latitude and phenotype

It has been postulated that site-specific variation in melanocytic nevus density and size is explained by differential response to sunlight. We observed the density and size of nevi at different body sites in relation to age, phenotype, latitude, and other measures of ultraviolet exposure. A standard protocol was used to assess nevi, phenotype, and sun exposure in 1123 Australian schoolchildren at 3 contrasting latitudes. Associations with phenotype (red hair, skin reflectance, sun sensitivity, and tanning) varied by body site. In Queensland, gender differences in nevus density on the back and lower limbs, unrelated to sun exposure, were similar to gender differences for melanoma. Small nevi (2-4 mm) were most dense on the arms, whereas large nevi (> or =5 mm) were most dense on the posterior trunk where they were related to age, decreasing latitude, male sex, and freckling. Our findings support the hypothesis of site-specific differences in nevus proliferative potential.     

A 20-year epidemiological study of cutaneous melanoma in the Rijeka district of Croatia

A retrospective study was made of the incidence of cutaneous melanoma among the population of the district of Rijeka (Croatia) during the period 1977-96. A total of 397 patients with cutaneous melanoma was documented during this period. Over the 20-year period the incidence of the tumour increased, the mean annual rate being 4. 8 (4.0 in males and 5.4 in females) in the first 10-year period and 7.16 in the second (7.1 in males and 7.3 in females). The number of registered cases in males and females was almost identical (1 : 1.05). The number of melanoma cases increased with age in both sexes, whereas it was rare in children. The most affected anatomical location was the trunk in males and the lower limbs in females. The results indicate the need for active prevention and educational programmes in this population.     

Melanoma in Kauai, Hawaii, 1981-1990: the significance of in situ melanoma and the incidence trend

BACKGROUND: The incidence of melanoma has often been portrayed as reaching 'epidemic' proportions. The reality of such an epidemic is, however, not clearly established due to the methods of data collection and interpretation. The population-based incidence data and incidence trend of melanoma from the Island of Kauai, Hawaii provide an illustration of this 'epidemic'. METHODS: We used medical records housed at the dermatology clinic and pathology laboratory in Kauai to: identify residents of Kauai who had their first melanoma during the years 1981-1990; and to measure the 10-year population-based incidence of melanoma. RESULTS: In Caucasians: A total of 53 Caucasian residents (29 men and 24 women), were identified with an initial episode of melanoma (MM) during the 10-year period. The average annual standardized incidence rate per 100,000 Kauai Caucasian residents was 36. Whereas the incidence of in-situ MM increased during the 10-year period, the incidence of invasive MM did not. The average patient age was 55 years. The trunk and the limbs were the most common anatomic sites of MM. In men, one third of MM occur on the back. In women, one third develop on the leg/thigh. Three patients (6%) had metastasis and eventually died of MM. Thirteen patients (25%) had other skin cancers such as basal cell carcinoma and squamous cell carcinoma at some time. In Filipinos, Japanese and Hawaiians: Three Filipinos (all women), two Japanese (one man and one woman) and one Hawaiian (man) had melanoma. The standardized incidence rates, to the U.S.A. Caucasian population, were 3.1, 0.8 and 2.1 per 100,000 residents, respectively. CONCLUSIONS: The melanoma incidence in Kauai is one of the highest rates documented in the U.S.A. However, a decreased incidence of invasive melanoma during the 10-year period was unexpected. The finding of nonmelanoma skin cancer in these patients supports a common etiology among these skin cancers.     

Clinical and pathological characteristics of melanoma: a population‐based study in a French regional population

Background Although incidence and mortality data are numerous, population‐based studies including clinical and pathological characteristics of melanoma are rare. Objectives To describe the characteristics of melanoma in a rural French region during 2004–2008 and to identify differences according to age, gender and geographical areas. Methods Pathology reports of cutaneous melanomas diagnosed in residents from the Champagne‐Ardenne region during 2004–2008 were anonymously collected from pathology laboratories. Demographic, clinical and pathological data were extracted and analysed by experts, including dermatologists, pathologists and epidemiologists. Results One hundred and seventy‐seven in situ melanomas were diagnosed in 177 patients (female/male ratio : 1.72). Patients with head and neck in situ melanomas were older than patients with melanomas in other locations (72 vs. 54 years; P < 0.0001). Six hundred and sixty‐one invasive melanomas were diagnosed (female/male ratio : 1.26), corresponding to an annual incidence rate of 6.3/100 000. Male patients had thicker and more frequently ulcerated tumours. The location widely varied between genders, involving the trunk in 47% of male patients and the lower limb in 48% of female patients. Older patients had thicker and more advanced melanomas, with a more frequent head and neck location. Nodular, acral lentiginous and unclassified melanomas were much thicker than superficial spreading and lentigo maligna melanomas (4.37 vs. 1.33 mm, P < 0.0001). Primary melanomas of advanced stages were more frequent in one of the four districts of the study area. Overall, the mean Breslow thickness (2.02 mm) was much higher than that previously observed in other regions of north‐eastern France (1.59 mm). Conclusions Information and screening campaigns should particularly target rural areas, males, older people and focus on nodular, acrolentiginous and unclassified subtypes.     

Epidemiology and clinical and pathologic characteristics of cutaneous malignant melanoma in Abruzzo (Italy)

Background  Malignant melanoma incidence has increased worldwide in recent decades. Cancer registry-derived epidemiologic data on malignant melanoma in Italy are available only in some northern regions of the country.
Aim  To report the number and characteristics of incident cases of cutaneous malignant melanoma in Abruzzo, a central-southern Italian region.
Methods  Screening of the archives of the pathology departments of regional hospitals from 2002 to 2005 was performed. For each patient, clinical and pathologic data were collected. Cases of metastatic, multiple, or relapsing melanoma were excluded.
Results  Six hundred and seventy-two cases of primary melanoma were recorded, with an incidence rate of 14.1 per 100,000 inhabitants per year. Differences related to gender (41.1% males and 58.9% females) and age (35% in the 50–70-year age group) were found. The trunk (30.7%) and lower limbs (25.94%) were the most frequent sites observed. The superficial spreading histiotype and thin melanoma (≤ 1.00 mm) were more often recorded (44.8% and 62%, respectively).
Conclusions  Despite the bias present in this study, linked to the nature and source of the data, we believe that the figures found in this report are comparable with those obtained in the international literature from other Mediterranean countries.     

Critical evaluation of the variants influencing the clinical response of vitiligo: study of 60 cases treated with ultraviolet B narrow-band phototherapy

BACKGROUND: The treatment of vitiligo is still a challenge, but ultraviolet B narrow-band (UVB-NB) therapy has been recently reported to be an effective and safe therapeutic option in patients with vitiligo. OBJECTIVE: The purpose of this study is a critical evaluation of the variants (body sites, age, duration of the disease, and duration of the therapy) influencing the clinical response to UVB-NB therapy. METHODS: Sixty patients (23 male and 37 female), aged 6 to 70 years, with vitiligo, were treated with UVB-NB therapy over a maximum period of 2 years. The evaluation of the percentage of repigmentation was done through photographs. RESULTS: The lesions located on the face obtained a complete repigmentation in 68% of the patients, on the neck in 57.89%, and on the trunk in 50% within the first year of the therapy. In young patients vs. adults patients, the lesions located on the neck obtained a complete repigmentation in 83.33% vs. 46.15%, on the upper limbs in 28.57% vs. 9.52%, and on the lower limbs in 25% vs. 16.67%. In patients with vitiligo of recent onset, the lesions located on the neck obtained a complete repigmentation in 83.33%, on the upper limbs in 33.33%, and on the lower limbs in 28.57%. Hands did not give a positive response in either groups. CONCLUSION: This study shows that certain body sites respond better than others to the UVB-NB therapy; patients, aged less than 20 years, with recent vitiligo, achieve more repigmentation; the duration of the therapy can influence the response of the lesions over hands and lower limbs, showing only mild repigmentation.     

Site-specific melanocytic naevus counts as predictors of whole body naevi

Counts of melanocytic naevi of 2 mm or greater diameter on all body sites were conducted in 197 Caucasian adults in Scotland. Mean naevus numbers were greater in young than in older adults, and in females than in males. Naevus counts on the upper limbs, lower limbs, and trunk were strongly and significantly correlated with each other and with whole body counts. Thus, where whole body counts are impractical, counting naevi at any of these individual sites should provide a satisfactory method for studying naevus distribution in large populations.     

Melanoma in South‐East Europe: epidemiological data from the central cancer registry and clinicopathological characteristics from the hospital‐based registry in Serbia

Background Melanoma in South‐East Europe shows varying incidence from 1.7 per 100,000 in Albania to 14.5 per 100,000 in Slovenia, but more detailed data from this region are scarce. In this study, we report epidemiological and clinicopathological characteristics of melanoma in central Serbia. Materials and methods Epidemiological data were retrieved from the Cancer Registry of Central Serbia and clinicopathological data from the hospital‐based registry. Results The ASR(W) incidence rate of melanoma was 4.2/100,000 (males) and 3.9/100,000 (females), and ASR(W) mortality rates were 1.9/100,000 (males) and 1.4/100,000 (females), with recorded rising trends in both of them. Data from the hospital‐based registry revealed a total of 266 patients treated from 2005 to 2010, with the median age at diagnosis of 57 (13–86) years. The most frequent histopathological subtype was superficial spreading melanoma (SSM; 63.53%), and ulceration was present in 40.6% of primary tumors. Median Breslow thickness was 3 mm (0.1–25 mm). Primary tumors with thickness of more than 4 mm were found in 31.95% of patients, and in this group statistically significant difference was found for younger age in patients with SSM (55 years vs. 61 years, P = 0.04). Conclusion Low incidence rates in central Serbia and probably other countries of South‐East Europe are accompanied by a large percentage of thick tumors and a significant proportion of younger patients with thick tumors. This points to the urgent need for more effective primary and secondary prevention of melanoma in these countries.     

Population‐based incidence and melanoma‐specific survival of cutaneous malignant melanoma in a Colombian population 2000–2009

Background

Demographic, clinical, and morphological characteristics of cutaneous melanoma are unknown for the Colombian population. We aim to provide these characteristics as well as population‐based incidence and survival data.

Methods

All patients with an invasive cutaneous melanoma diagnosed in the period 2000–2009 registered in the population‐based cancer registry of the metropolitan area of Bucaramanga were included for analysis (n = 169). Age‐standardized incidence rates were calculated and melanoma‐specific and overall survival estimated with follow‐up until June 9, 2016, using Kaplan–Meier methodology, stratifying for gender, anatomical localization, and type of affiliation to the social security system.

Results

The age‐standardized melanoma incidence rate was 1.7 per 100,000, with lower limbs being the most affected body sites (42.6% of all melanomas). A high proportion of melanomas presented on the plants or palms (16%) and under the nails (7.1%); at least 24.3% of melanomas were ulcerated, and 21.1% had a Breslow thickness more than 2 mm. Melanoma‐specific 5‐year survival was 79.3%, with worst survival for melanomas localized on the plants (64.6%) and subungual areas (55.6%). Affiliation to the subsidized type of affiliation to the social security system was statistically significantly (P = 0.003) associated with poorer survival (68.8%) compared to the special regimes (95.8%).

Conclusions

Melanoma is a relatively rare cancer in Colombia with mainly the acral sites, high proportion of thick and ulcerated melanomas, and relatively poor survival being distinct features, indicating the need for tailor‐made primary and secondary prevention strategies. Better training of pathologists in the difficult field of melanoma would improve precision of available data.     

Rising trends in incidence of cutaneous malignant melanoma and their future projections in Catalonia,Spain: increasing impact or future epidemic?

Background During the past decades, there has been a substantial increase in the incidence of cutaneous malignant melanoma (CMM) among all Caucasian populations. Spain presents one of Europe’s lowest incidence and mortality rates. Objective The aim of this study was to analyse the recent trends of CMM incidence and mortality in a region with lower incidence as well as to project their future trends. Methods Cutaneous malignant melanoma incidence data were provided by the Tarragona and Girona population‐based cancer registries and mortality data were provided by the Mortality Registry of Catalonia. Time trends of incidence and mortality rates by CMM were assessed through the estimated annual percentages of change of the incidence and mortality age‐standardized rates to the World Standard Population. Projections were based on a Bayesian age–period–cohort model using second order autoregressive effects on age. Results During the last 20 years CMM incidence has increased substantially at a faster rate than any other neoplasms in Catalonia, particularly among women and this trend will probably continue for the next several years. Nevertheless, CMM mortality trends have been and probably will remain stable during this period. Conclusion Improvements in preventive activities should be implemented to decrease incidence and mortality from this cancer. Monitoring stage‐specific trends in CMM incidence can assess the impact of preventive strategies; for this reason more complete information on diagnostic features of CMM patients in the Spanish population‐based cancer registries are necessary.