Elsevier

European Journal of Cancer

Volume 92, March 2018, Pages 108-118
European Journal of Cancer

Original Research
Trends in incidence of thick, thin and in situ melanoma in Europe

https://doi.org/10.1016/j.ejca.2017.12.024Get rights and content

Highlights

  • This study is the most recent analysis of melanoma trends in Europe by lesion thickness.

  • We analysed about 415,000 cases incident between 1995 and 2012 from 13 European countries.

  • Results showed that the incidence of invasive melanoma continues to increase, mainly due to thin lesions.

  • There was a large variation in trends among countries, with the greatest increase in the Netherlands.

  • Mortality from invasive melanoma continued to increase in some countries.

Abstract

Background

We analysed trends in incidence for in situ and invasive melanoma in some European countries during the period 1995–2012, stratifying for lesion thickness.

Material and methods

Individual anonymised data from population-based European cancer registries (CRs) were collected and combined in a common database, including information on age, sex, year of diagnosis, histological type, tumour location, behaviour (invasive, in situ) and lesion thickness. Mortality data were retrieved from the publicly available World Health Organization database.

Results

Our database covered a population of over 117 million inhabitants and included about 415,000 skin lesions, recorded by 18 European CRs (7 of them with national coverage). During the 1995–2012 period, we observed a statistically significant increase in incidence for both invasive (average annual percent change (AAPC) 4.0% men; 3.0% women) and in situ (AAPC 7.7% men; 6.2% women) cases.

Discussion

The increase in invasive lesions seemed mainly driven by thin melanomas (AAPC 10% men; 8.3% women). The incidence of thick melanomas also increased, although more slowly in recent years. Correction for lesions of unknown thickness enhanced the differences between thin and thick cases and flattened the trends. Incidence trends varied considerably across registries, but only Netherlands presented a marked increase above the boundaries of a funnel plot that weighted estimates by their precision. Mortality from invasive melanoma has continued to increase in Norway, Iceland (but only for elder people), the Netherlands and Slovenia.

Introduction

The incidence of cutaneous malignant melanoma has increased steeply since the Second World War [1], [2], [3], [4], [5], [6], [7] although recent observations show a stabilisation of rates in North America and Australia [2]. In these countries, prevention campaigns and interventions aimed at early diagnosis have been implemented, with the aims of limiting solar exposure (especially at younger ages) and of detecting suspicious lesions as early as possible. However, a clear decrease in melanoma mortality in all age groups [8], [9], [10], [11] has not yet been observed.

Some countries have recently noted evidence of decrease in the incidence of invasive melanoma. However the reasons for the decline are not clear from the data and may be due to sun prevention campaigns or earlier diagnosis or both. An important element in understanding the trends is the concurrent behaviour of in situ, thin and thick lesions. Some studies have shown that the incidence of in situ and thin melanomas has been increasing faster than that of thick melanomas [9], [12], [13], [14], [15], [16], [17], [18], [19].

At present, information on the incidence of in situ, thin and thick lesions is collected by many cancer registries in Europe, but statistics on thickness are not available on a routine basis from most of the public access sites. In addition, published studies often focus on the national burden of the disease, lacking a broader European perspective.

This article investigated melanoma incidence and mortality in 13 European countries during the period 1995–2012. To better understand trends, analyses were performed by country, age, sex and Breslow thickness.

Section snippets

Materials and methods

Individual anonymised incidence data (with corresponding population files) were collected from population-based European cancer registries (CRs) through an ad hoc call. CRs directors and researchers received the study protocol by e-mail by the end of year 2015. CRs were selected on the basis of a long history of high-quality data (as proven by inclusion in the last two editions of Cancer Incidence in Five Continents, low percentages of DCO and high proportions of MV for melanoma); at least ten

Results

Our database covered a population of over 117 million inhabitants and included about 415,000 skin lesions, recorded by 18 European CRs (7 of them with national coverage) in 13 countries, between 1995 and 2012 (Table 1). Incidence rates of invasive melanoma in men varied from a low of 5.6 per 100,000 in Tarragona, Spain to 24/100,000 in Geneva, Switzerland, where the highest rate of in situ lesions was also observed, 23/100,000 in men in 2012 (Table 1). Incidence rates were higher among females

Discussion

Melanoma incidence trends in Europe have been previously analysed at a national level [3], [8], [9], [10], [14], [15], [16], [17], [18], [19], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34]. However, the different periods considered and methods used have hampered comparisons between countries. Moreover, differences in incidence and mortality trends in both time and space have made it difficult to interpret mortality-incidence ratios, which are often used as a proxy for

Conflict of interest statement

None declared.

Contributors

TIM (Trends in Melanoma) Working Group

Austrian Cancer Registry (Austria): Monika Hackl, Henrike Karim-Kos; Belgium Cancer Registry (Belgium): Lisbeth Van Eycken; Schleswig–Holstein Cancer Registry (Germany): Alexander Katalinic, Miriam Holzmann; Iceland Cancer Registry (Iceland): Laufey Tryggvadóttir, Elinborg Ólafsdóttir; Ireland Cancer Registry (Ireland): Harry Comber; Piedmont Cancer Registry. (Italy): Roberto Zanetti, Stefano Rosso, Lidia Sacchetto, Paolo Broganelli; Ragusa Cancer Registry

Acknowledgements

Lidia Sacchetto presented this work at the IACR Meeting 2016 in Marrakesh (Morocco) and has been awarded the “Enrico Anglesio” Prize, offered by the Anglesio Moroni Foundation, Turin, Italy. This study was supported by a research grant (grant number 2015.AI329.U390) of the Fondazione Cassa di Risparmio di Torino, Turin, Italy; the grant funded a one-year scholarship to LS. The authors would like to thank the TIM WG (Trends in Melanoma Working Group) members for contributing to this study with

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