Trends in malignant melanoma of skin in New Zealand

Melanoma signature in Brazil: epidemiology, incidence, mortality, and trend lessons from a continental mixed population country in the past 15 years

The current research aimed to understand melanoma epidemiology in Brazil and to evaluate temporal trends in incidence and mortality. The data came from Brazilian Hospital Cancer Registries, Population Based Cancer Registries, and the National Mortality Information System from 2000 to 2014. Descriptive statistics were used for epidemiological and clinical characteristics. To describe trends in change in incidence and mortality rates, the Average Annual Percentage Change (AAPC) was calculated. Between 2000 and 2013, in men, the median incidence rate rose from 2.52 to 4.84, with an AAPC of +21.5% [95% confidence interval (CI): 15.4-28] and in women from 1.93 to 3.22 per 100 000, with an AAPC of +13.9% (95% CI: 8.1-20). Regarding mortality, between 2000 and 2014, the rates went from 0.85 to 0.9 per 100 000 for men (AAPC=+0.8, 95% CI: 0.4-1.1) and from 0.56 for 0.53 per 100 000 for women (AAPC=-0.1, 95% CI: -0.2 to 0). From the database, a total of 28 624 patients with melanoma were included. Most of the patients were females (51.9%), White (75%) and with stage I or II (53.2%). Sex, ethnicity, education level, geographical area of the cancer center, topography, histology, time between diagnosis and treatment, and early death were significantly associated with distant metastases. Brazil is a large country with a very young population and a low rate of melanoma incidence and prevalence that should increase over the years. Understanding the trends attributed to melanoma is important for behavioral counseling interventions that focus on promoting skin cancer prevention.

Basal Cell Carcinoma: Review of Epidemiology, Pathogenesis, and Associated Risk Factors

Background:

Basal cell carcinoma (BCC) is extremely common, and its incidence continues to rise.

Objective:

This review presents the literature pertaining to the epidemiology, pathogenesis, and risk factors associated with BCC.

Conclusions:

The risk of developing BCC depends on both genetic predisposition and exposure to risk. Fair-skinned people account for the overwhelming majority of patients, beyond what would be expected by skin phototype alone. Damage to multiple lines of defense appears to be necessary for cancer development and spread. This damage distorts the concerted effort of deoxyribonucleic acid (DNA) repair, immunosurveillance, and cellular growth regulation to protect against malignant progression. Ultraviolet light exposure is the most critical modifiable factor determining early expression and frequency of BCC development.

A comparison of trends in melanoma mortality in New Zealand and Australia: the two countries with the highest melanoma incidence and mortality in the world

Background

New Zealand and Australia have the highest incidence and mortality rates from cutaneous melanoma in the world. The predominantly fair-skinned New Zealanders and Australians both enjoy sun, tanned skin and the outdoors, and differences in these activities among generations have been important determinants of trends in melanoma mortality.

We examined whether New Zealand trends in melanoma mortality mirror those in Australia, through detailed comparison of the trends in both countries from 1968 to 2007.

Methods

Five-year age-specific and age-standardised mortality rates were calculated for each country for 5-year time periods. Tests for trends in age-specific rates were performed using the Mantel-Haenszel extension chi-square test. The age-adjusted mortality rate ratios for New Zealand/Australia were plotted against period of death to show relative changes in mortality over time. Age-specific mortality rates were plotted against period and the median year of birth to illustrate age-group and birth cohort effects. To compare the mortality of birth cohorts, age-adjusted melanoma mortality rate ratios were calculated for the birth cohorts in the quin-quennial tables of mortality rates.

Results

The age-standardised mortality rate for melanoma increased in both sexes in New Zealand and Australia from 1968 to 2007, but the increase was greater in New Zealanders and women in particular. There was evidence of recent significant decreases in mortality in younger Australians and less so in New Zealand women aged under 45 years. Mortality from melanoma increased in successive generations born from about 1893 to 1918. In Australia, a decline in mortality started for generations born from about 1958 but in New Zealand there is possibly a decrease only in generations born since 1968.

Conclusions

Mortality trends in New Zealand and Australia are discrepant. It is too early to know if the pattern in mortality rates in New Zealand is simply a delayed response to melanoma control activities compared with Australia, whereby we can expect the same downward trend in similar age groups in the next few years. Specific research is needed to better understand and control the increases in mortality and thickness of melanoma in New Zealand.

Years of potential life lost and indirect costs of melanoma and non-melanoma skin cancer: a systematic review of the literature

Skin cancer is the most common form of cancer in the US, and an important public health concern both in the US and throughout the world. Given high incidence rates among young adults and the large number of deaths, skin cancer has the potential to result in significant years of potential life lost (YPLL) and lost productivity. The purpose of this study was to systematically review the published literature on the YPLL and the value of productivity loss from morbidity and premature mortality resulting from melanoma and non-melanoma skin cancer (NMSC). Employing pre-defined search terms and inclusion/exclusion criteria, systematic searches were conducted in MEDLINE, EMBASE, CINAHL and Econlit. We selected studies that measured the societal burden of melanoma and NMSC - through estimating either the YPLL and/or the indirect costs. We identified 16 relevant studies meeting our criteria, six were from the US and ten were from other industrialized countries; ten of the studies reported results on YPLL, eight on mortality costs and five on morbidity costs. Some studies reported results in more than one category. From each eligible article and report, we extracted detailed information on the study population/country, study design, data analysis methods and study results. Data abstracted for each eligible study included estimated number of YPLL, YPLL per death and morbidity and mortality costs. The average number of YPLL per death was approximately 15 for melanoma and 10 for NMSC. We found the costs attributable to melanoma and NMSC ranged from $US39.2 million to $US28.9 million for morbidity and $US3.3 billion to $US1.0 billion for mortality, respectively. It is clear from the published literature that skin cancer leads to significant YPLL and indirect costs associated with premature mortality and morbidity. Prevention and early detection efforts are important in helping reduce the incidence of melanoma and NMSC, and the related deaths and productivity losses.

Cutaneous malignant melanoma in Europe

Cutaneous malignant melanoma is on the rise in fair skinned societies. Both its incidence and mortality rates have been increasing in Europe over the past decades, the latter seem to stabilise in Scandinavia. The main cause of melanoma is intermittent exposure to ultraviolet radiation, especially in combination with endogenous factors like skin type and genetic predisposition. Evidence on an association between sunbed use and melanoma is inconclusive, but seems to point to a slightly increased risk associated with sunbed use. Within Europe, considerably variation in patterns of melanoma incidence and mortality existed. In this paper, we discuss the possible explanations for the observed trends and options for primary and secondary prevention. Early detection seems the most promising way to combat the relatively poor survival rates in Southern and Eastern Europe.

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.

Malignant Melanomas Treated By Plastic Surgeons in Hamilton, Ontario: A Retrospective Study of 80 Patients with Clinical and Histological Correlation

The present retrospective study was designed to analyze the clinical and survival data of 80 patients diagnosed between 1969 and 1987 with confirmed invasive malignant melanoma in Hamilton, Ontario and surrounding region. The age of peak incidence was 31 to 40 years of age for men and 51 to 60 years of age for women. The most frequent type of melanoma was superficial spreading. The most frequent sites were the upper back, ankle and leg. The six-year survival rate for all the patients was 63%. Patients below 50 years of age had a significantly better survival rate than patients above 50 years of age. Survival appears to be inversely proportional to tumour thickness. The findings in this study are similar to those of previous studies regarding clinical features and prognosis. Patient age, and tumour histology and thickness remain important prognostic factors in determining survival for invasive malignant melanoma.

Skin cancer. Melanoma and other specific nonmelanoma skin cancers

BACKGROUND

Malignant melanoma accounts for most of the growing mortality from skin cancer. However, survival rates are increasing for individual cases, probably because of earlier diagnoses.

METHODS

Skin cancers collected by the SEER population-based data base between 1973 and 1987 are described in terms of their histologic classification and their distribution by sex, race, anatomical location, geographic locality, and time period of occurrence.

RESULTS

There were 30,519 invasive skin cancers in the 15-year reporting period. Because the common basal cell and squamous cell cancers are not reportable to SEER, most of the cancers (28,206) were melanomas. In addition, 4386 in situ melanomas were reported. The rate of melanoma was 13-fold higher in whites than in blacks and 29% higher in white males than in white females. There was a 52% increase in the age-adjusted incidence rate for invasive melanoma and a 600% increase in the incidence rate of in situ melanoma over the 15-year period for whites and a 12% decrease in the incidence rate of invasive melanoma in blacks. The incidence of melanoma in the ear and trunk predominated in males, whereas melanoma of the lower limb predominated in females. Incidence rates and rate of increase of incidence of melanoma varied by anatomical subsite, sex, and geographic location within the United States.

CONCLUSIONS

The variations among incidence rates of melanoma by sex, subsite, race, geographic location, and time period support prevailing theories of a solar cause for most but not all cases of this disease. Although melanoma rates are rising overall, the disproportionate rise in the rate of diagnosis of in situ compared with invasive melanoma suggests that melanomas are being diagnosed earlier.

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 years, the effects of age, time period, birth-cohort, gender, and region (latitude), and some interactions between them were evaluated by log-linear 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 degrees S) compared with the most northern region (latitude 36 degrees 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.

Cutaneous malignant melanoma and ultraviolet radiation: a review

Cutaneous malignant melanoma (CMM) rates have been increasing in the United States at an average rate of about 4% per year. In 1987, it was estimated that there would be 25,800 cases and 5,800 deaths from CMM in the United States. The exact cause of the increase in unknown, but there is evidence to suggest that increasing exposure to the ultraviolet B (UVB) radiation present in sunlight may be partly responsible. The evidence includes: 1. the fact that higher CMM incidence rates are observed in people with lesser amounts of skin pigment (which blocks penetration of UV); 2. a correlation of higher CMM rates with decreasing latitude and increasing UVB levels; 3. the observation that freckles and nevi (precursors to CMM) are induced by solar exposure; 4. differences in CMM rates between natives and immigrants to sunny climates; 5. high rates of CMM in patients who cannot repair UVB-induced DNA damage; and 6. the indication that sun exposure at early ages and of an intermittent nature results in higher CMM risks. With the concern that depletion of stratospheric ozone could result in increasing levels of UVB, it has become important to understand the relationship between UVB and CMM in order to estimate the increases in CMM that would be expected with ozone depletion. When empirical relationships between UVB and CMM incidence and mortality rates were derived and used to estimate the impact of stratospheric ozone depletion, a 1% depletion of ozone was predicted to result in increases of 1%-2% in CMM incidence and 0.8%-1.5% in CMM mortality.

Are malignant melanoma time trends explained by changes in histopathological criteria for classifying pigmented skin lesions?

The incidence of malignant melanoma in developed countries has been rising rapidly in recent years. Its causes and the reasons for this trend are uncertain. Changes in histopathological criteria for classifying pigmented skin lesions could explain the rising incidence rates. With support from the International Agency for Research on Cancer, this hypothesis is explored but not substantiated for time trends in the South Western Region, United Kingdom.

Melanoma in Western Australia 1975-76 to 1980-81: trends in demographic and pathological characteristics

Trends in incidence rates of cutaneous malignant melanoma in Western Australia from 1975-76 to 1980-1981 have been examined with reference to age, sex, body site, presence or absence of dermal invasion, tumour thickness, histological type, socioeconomic status and occupation. The incidence rates of all melanomas increased from 22.1 to 31.5 per 100,000 person-years in males and from 23.6 to 28.6 in females. In males, the relative annual increase in the incidence of invasive melanoma was 2.2%, and in females it was 5.6%. In-situ melanomas had larger relative increases in incidence (28% per annum in males and 10% in females) and the thickness of invasive lesions decreased between 1975-76 and 1980-81. The relative increase in incidence of invasive melanomas was greatest on the body sites with the highest rates initially--the trunk in males and the lower limbs in females. There was an increase in the proportion of invasive lesions classified as superficial spreading melanoma. The increase in incidence of in situ melanomas was largely restricted to the head and neck in older men of high socioeconomic status resident in Perth. This trend in in-situ melanoma was mainly due to an increase in the recorded incidence of Hutchinson's melanotic freckle. It may have been, in part, an artefact due to increased recognition of Hutchinson's melanotic freckle in this sub-group of the population.

Migration and death from malignant melanoma

The age-standardized mortality rates for malignant melanoma of the skin in immigrants to New Zealand were compared with those of New Zealand-born non-Maoris. Immigrants from European countries had mortality rates that were generally similar to those prevailing in their countries of origin, although, among immigrants from the British Isles, early age at migration was associated with a mortality rate similar to that of New Zealand-born non-Maoris. In a community survey, British immigrants were not less likely to have had severe sunburn, but had fewer moles, than New Zealand-born non-Maoris. The lower melanoma mortality, and the effect of age at migration, could be mediated by differences in mole frequency.

Frequency of moles in a defined population

The occurrence of moles was studied in a community survey of 872 adults, using criteria that allowed comparison with two earlier surveys. Men and women had similar numbers of moles-on average, 15 moles of diameter 2 mm or greater, and 39 moles of all sizes. The frequency of moles declined with age and varied according to body site. Comparison of the findings with those of previous surveys-in New York in about 1950 and in Sydney in about 1970-suggested that the frequency of moles has increased as malignant melanoma has become more common. Little is known about the epidemiology of moles, which may hold the key to the explanation of the rising incidence of melanoma in many countries.