Global Perspectives of Contemporary Epidemiological Trends of Cutaneous Malignant Melanoma

M.B. Lens; M. Dawes

Disclosures

The British Journal of Dermatology. 2004;150(2) 

In This Article

Incidence of Cutaneous Malignant Melanoma

The number of melanoma cases worldwide is increasing faster than any other cancer. The annual increase in incidence rate varies between populations, but in general has been in the order of 3-7% per year for fair-skinned Caucasian populations.[1] The estimates suggested a doubling of melanoma incidence every 10-20 years.[2] Table 1 shows incidence rates of CMM for 23 selected countries reported in GLOBOCAN 2000.[3]

In Australia, CMM is the fourth most common cancer among males (after prostate cancer, bowel cancer and lung cancer) and the third most common cancer among females (after breast cancer and bowel cancer).[4] Until recently, Queensland, Australia, has had the highest melanoma incidence rate in caucasians. In the period between 1980 and 1987 the reported annual incidence of invasive melanoma in Queensland was 55.8 per 100 000 inhabitants for men and 42.9 per 100 000 inhabitants for women.[5] The incidence of melanoma in men almost doubled during this period, reaching epidemic proportions, particularly in individuals over age 50 years. Similar incidence rates were documented in New South Wales, Australia, where between 1986 and 1988 the annual incidence of invasive melanoma was 52.5 per 100 000 in men and 42.9 per 100 000 in women.[6]

Melanoma incidence data for Australia for 1983-1999 are presented in Figure 1. Recently reported statistical data suggest that the lifetime risk for development of melanoma in Australia is now 1 in 25 for men and 1 in 34 for women.[7] The incidence of melanoma has been decreasing in young women since the mid 1980s, but has continued to rise in older age groups.[8]

Figure 1.

Age-adjusted melanoma incidence (per 100 000) in Australia, 1983-1999 (data from the National Cancer Statistics Clearing House at the Australian Institute of Health and Welfare).

Analysis of the data from New Zealand suggested that in 1999 the caucasian population in the region of Auckland, New Zealand, has the highest documented incidence of melanoma in the world, with the crude annual incidence for invasive CMM of 77.7 per 100 000 and the age-standardized annual rate of 56.2 per 100 000, with no statistically significant differences in the rates for males and females. The cumulative risk of developing melanoma over a lifetime in New Zealand has been reported to be 5.7% overall (5.9% for males and 5.4% for females).[9]

The data from the U.S. Surveillance, Epidemiology, and End Results (SEER) registry (covering approximately 14% of the U.S. population) showed that malignant melanoma was the most rapidly increasing malignancy in both sexes in the U.S.A. during 1973-1997. In that period the age-adjusted melanoma incidence rates (expressed as the number of cases per 100 000 person-years of observation) almost tripled among males, from 6.7 in 1973 to 19.3 in 1997, and more than doubled among females, from 5.9 to 13.8.[10] The age-adjusted incidence (per 100 000 population) of all melanomas among SEER Registries in the U.S.A. in the period from 1973 to 2000 is presented in Figure 2. The SEER age-adjusted incidence rate for melanoma diagnosed in the period from 1996 to 2000 was 21.8 among males and 14.5 among females.[11] The incidence of malignant melanoma has increased steadily in the U.S.A.: in 1935 the lifetime risk of an American developing melanoma was 1 in 1500 individuals, while in 2002 the risk was 1 in 68 individuals.[12] Figure 3 shows the lifetime risk of developing melanoma in the U.S.A. A statistical calculation estimated that in 2003 CMM will be the fifth most common cancer among males and the seventh most common cancer among females in the U.S.A.[13] In 2003, it is estimated that 54 200 Americans will be diagnosed as having melanoma, and 7600 will die of the disease.

Figure 2.

Age-adjusted (2000 U.S. standard population) melanoma incidence (per 100 000), nine registries, 1973-2000 (data from the SEER Program of the National Cancer Institute).

Figure 3.

Lifetime risk of developing malignant melanoma in the U.S.A.

Trends in melanoma incidence by anatomical site were examined in Canada, where ascertainment of cancer has been of a high standard. The analysis of 41 239 patients with malignant melanomas registered in Canada between 1969 and 1993 showed that the estimated annual increase in incidence was 4.8% for males and 3.1% for females.[14] The largest relative increases occurred for the upper limbs (5.7% annual change for males and 4.3% for females), followed by the trunk (5.6% annual change for males and 3.6% for females).

In Europe the highest incidence rates have been reported in Scandinavia (about 15 cases per 100 000 inhabitants per year) and the lowest in the Mediterranean countries (about five to seven cases per 100 000 inhabitants per year).[15]

In Sweden, age-adjusted incidence rates (per 100 000 population) were 11.6 for males and 10.9 for females in 1981, while the rates in 1991 were 18.0 and 15.6, respectively. The increase was less prominent in the period between 1991 and 2000, with incidence rates of 19.6 for males and 17.4 for females in 2000.[16] A study evaluating incidence trends of CMM in situ in Sweden in 1968-1992 demonstrated that among men, age-standardized rates increased from 0.1 per 100 000 in 1968 to 2.9 per 100 000 in 1992 (mean annual increase of 15.0%), while among women rates increased from 0.3 to 3.7 per 100 000 (mean annual increase of 12.8%).[17] Analysis of the trend in incidence of CMM in the Swedish population in the period 1976-1994 showed an upward incidence trend not only for in situ melanoma but also for invasive melanoma, although the estimated mean annual increase was about twice as large for in situ melanoma (9-10%) as for invasive melanoma (4-5%).[18]

Examination of the incidence of primary invasive melanoma in Northern Italy in the period 1986-1997 gave the age-standardized incidence of CMM of 7.57 per 100 000 in males and 11 per 100 000 in females. Between 1986-1991 and 1992-1997, the incidence of melanoma rose from 5.0 to 10.0 cases per 100 000 person-years in males and from 8.9 to 13.1 cases per 100 000 person-years in females.[19]

In the U.K. in 1996, CMM was the eleventh most common cancer in women and the twelfth most common cancer in men. Among people under 35 years, it is the third most common cancer in women and the fifth most common cancer in men. In 1997 melanoma contributed 2% to the total cancer burden in the U.K.[20] Incidence rates in the U.K. have increased from around 1.7 in 1971 to 8.0 per 100 000 population in 1997 for males, and from 3.1 to 9.7 per 100 000 population for females, a fourfold and a threefold rise, respectively. The incidence of CMM in the U.K. is presented in Figure 4.

Figure 4.

Incidence of cutaneous malignant melanoma in the U.K., age-standardized to the European standard population (rates per 100 000 population).

The analysis by the Scottish Melanoma Group of 8830 patients diagnosed as having invasive CMM (Clark level 2 or deeper) in Scotland, U.K., during the period 1979-1998, showed a steady and continuing rise in the incidence of invasive melanoma in both genders. Incidence rate (age-standardized) rose from 3.5 in 1979 to 10.6 per 100 000 population in 1998 among men, and from 7.0 to 13.1 among women.[21]

In the area of South Wales, U.K., analysis of the melanoma incidence trends in the period 1986-1998 showed a rise in incidence of 74% in the last 10 years. The age-standardized rate of 9.6 per 100 000 for males, and 14.5 for females, is one of the highest recorded in Europe.[22] Most of the increased incidence is ascribed to increased numbers of superficial spreading melanoma.[23]

This review has shown considerable variation in the incidence rates of melanoma worldwide. Reported data suggested more favourable incidence trends in some countries while in others the incidence of melanoma is still rising. Recent evidence suggests that the current trend of increased melanoma incidence is due to improved surveillance techniques with early diagnosis, together with changes in lifestyle in terms of excessive recreational exposure to sunlight.24,25 The overall increases in melanoma incidence have begun to slow in the later years in Western Europe and North America. One of the explanations for the slowing in the melanoma incidence rates in these countries is the decrease in sun exposure of the type likely to cause melanoma (improved sun exposure behaviour), particularly to parts of the body normally covered by clothes. With effective skin cancer prevention campaigns and public education, further declines in incidence can be expected over the coming years.

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