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Krensel M, Schäfer I, Augustin M. Modelling first-year cost-of-illness of melanoma attributable to sunbed use in Europe. J Eur Acad Dermatol Venereol 2019; 33 Suppl 2:46-56. [PMID: 30811692 DOI: 10.1111/jdv.15313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Melanoma is a life-threatening disease of the skin with an increasing incidence of approximately 87 000 new cases treated per year in the European Union and the European Free Trade Association states resulting in considerable costs for the society. Since the use of sunbeds is known to be a risk factor, which can be easily avoided, costs of malignant melanoma attributable to sunbed use are modelled in the present study. METHODS Costs-of-illness of melanoma were calculated and compared for all member states of the European Union and the European Free Trade Association states using an established modelling approach. Calculations were based on a systematic literature research. For countries with no available information on cost-of-illness the gross domestic product, health expenditures and gross national income served as a basis for extrapolation of costs. International comparison was enabled by adjusting costs by the national purchasing power parity. RESULTS After adjusting melanoma treatment costs for the purchasing power parity, direct costs per patient vary between € 1056 in Romania and € 10 215 in Luxembourg. Costs due to morbidity range from € 102 per patient in Sweden and € 5178 in the UK resulting in total costs of € 1751-€ 12 611 per patient. Average weighted total costs per patient amount for € 6861-€ 6967 annually. In total, in 2012 approximately 4450 new cases of melanoma have been induced by sunbed use in the 31 included countries, which corresponds to 5.1% of all incident melanoma cases. National attributable melanoma costs range from € 1570 in Malta to € 11.1 million in Germany and sum up to an amount of € 32.5-€ 33.4 million for all countries. CONCLUSION This article provides a first estimation on costs of melanoma in Europe. It illustrates the contribution of exposure to artificial ultraviolet light in the economic burden of malignant melanoma.
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Affiliation(s)
- M Krensel
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - I Schäfer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Barbaric J, Laversanne M, Znaor A. Malignant melanoma incidence trends in a Mediterranean population following socioeconomic transition and war: results of age-period-cohort analysis in Croatia, 1989-2013. Melanoma Res 2017; 27:498-502. [PMID: 28800032 DOI: 10.1097/cmr.0000000000000385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The aim of this study was to analyse trends of malignant melanoma incidence in Croatia for men and women of different age groups by birth cohorts and time periods, and to interpret them in the context of national socioeconomic changes over time and the possible implications for future prevention in South-Eastern European postcommunist countries with high mortality rates. We used the Croatian National Cancer Registry data to analyse incidence trends of malignant melanoma of the skin (ICD-9 code 172 and ICD-10 code C43) in men and women aged 25-79 years by age-period-cohort modelling. Over the 25-year period, the incidence was increasing by 5.0% annually in men and 4.6% in women. The age-period model provided the best fit for data in both sexes, with steeply increasing incidence rates, followed by a stabilization after the 2000s. On the cohort scale, incidence rates increased in successive generations of men, whereas in women, the risk of malignant melanoma attenuated in recent cohorts. Even if some progress has been achieved in recent years, the increasing melanoma incidence without concomitant declines in mortality would indicate a need to rekindle prevention efforts in the country taking the specific socioeconomic context into account.
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Affiliation(s)
- Jelena Barbaric
- aAndrija Stampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia bSection of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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de Vries E, Sierra M, Piñeros M, Loria D, Forman D. The burden of cutaneous melanoma and status of preventive measures in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S100-S109. [PMID: 27034057 DOI: 10.1016/j.canep.2016.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 01/29/2016] [Accepted: 02/09/2016] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVE Very little is known about the burden of cutaneous melanoma in Central and South America, despite the existence of a reasonable amount of population-based data. We present data on melanoma incidence calculated in a standardized way for Central and South America, as well as an overview of primary and secondary prevention issues in the region. METHODS Cancer registry data on all incident cases reported in the different registries present in Central and South America were combined to provide registry-based country estimates of age-standardized, sex-specific cutaneous melanoma incidence overall, and by histological subtype and anatomical site. A literature search provided additional information. RESULTS Age-standardized incidence rates were between 1 and 5 per 100,000 and tended to be higher further away from the equator. Cutaneous melanomas of the acral type, mostly occurring on the lower limbs, are a distinguishing feature of melanoma in Central and South America in comparison with high-incidence areas. Several preventive measures, both primary and secondary, are in place, albeit largely without evaluation. CONCLUSION Due to incomplete registration and different registration practices, reliable and comparable data on melanoma were difficult to obtain; thus it is likely that the true burden of melanoma in Central and South America has been underestimated. The different characteristics of the cutaneous melanoma patient population in terms of anatomical site and histological type distribution imply a need for adapted primary and secondary prevention measures. The generally high ambient ultraviolet radiation levels require sufficient sun protection measures.
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Affiliation(s)
- Esther de Vries
- International Agency for Research on Cancer, Section of Cancer Surveillance, Lyon, France; National Cancer Institute, Directorate of Research, Surveillance, Prevention and Promotion, Colombia; Erasmus MC University Medical Center, Department of Public Health, Rotterdam, The Netherlands.
| | - Mónica Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, Lyon, France
| | - Marion Piñeros
- International Agency for Research on Cancer, Section of Cancer Surveillance, Lyon, France
| | - Dora Loria
- Argentinian Registry of Cutaneous Melanoma, Argentina
| | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, Lyon, France
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4
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Barbaric J, Sekerija M, Agius D, Coza D, Dimitrova N, Demetriou A, Safaei Diba C, Eser S, Gavric Z, Primic-Zakelj M, Zivkovic S, Zvolsky M, Bray F, Coebergh JW, Znaor A. Disparities in melanoma incidence and mortality in South-Eastern Europe: Increasing incidence and divergent mortality patterns. Is progress around the corner? Eur J Cancer 2016; 55:47-55. [PMID: 26773419 DOI: 10.1016/j.ejca.2015.11.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/23/2015] [Accepted: 11/18/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Most countries in South-Eastern Europe (SEE) have lower incidence, but higher mortality rates of malignant melanoma (MM) of the skin compared to North-Western Europe (NWE). We explored trends in MM incidence and mortality in SEE countries by sex and age and compared them with the trends in NWE. METHODS We obtained data on incident cases and deaths from MM (ICD-10 code C43) from 11 population-based cancer registries in Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Malta, Romania, Serbia, Slovakia, Slovenia and Turkey. We calculated age-specific rates for 25-49 ('young'), 50-69 ('middle aged') and 70+ years ('older') and estimated the average annual percent of change in incidence and mortality trends 2000-2010 according to age group and sex, using joinpoint regression analysis. FINDINGS The incidence rates of MM across the region were uniformly increasing. Significant increases in mortality rates were observed in middle aged men in Serbia and Bulgaria, middle aged women in Slovenia, older men in the Czech Republic, Serbia and Turkey, and older women in Slovenia and Serbia. INTERPRETATION While MM incidence rates were still increasing across SEE, mortality trends diverged and were less favourable than in NWE. Empowering cancer registration and improving the quality of incidence and mortality data will be essential for monitoring progress in MM control. In the context of prevention of melanoma, disparities in early detection appear to be widening the gap between SEE and NWE, while the provision of care to patients with advanced disease is likely to prove a challenge for regional healthcare budgets.
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Affiliation(s)
- Jelena Barbaric
- Agency for Quality and Accreditation in Health Care and Social Welfare, Department for Development, Research and Health Technology Assessment, Planinska 13, 10000 Zagreb, Croatia.
| | - Mario Sekerija
- Croatian National Cancer Registry, Croatian Institute of Public Health, Rockefellerova 7, 10000 Zagreb, Croatia.
| | - Dominic Agius
- Malta National Cancer Registry, Department for Health Information and Research, 95, G'Mangia Hill, Pieta, PTA 1313, Malta.
| | - Daniela Coza
- Regional Cancer Registry of Cluj, Oncological Institute 'Ion Chiricuta', Republicii Street 34-36, 400015 Cluj-Napoca, Romania.
| | - Nadya Dimitrova
- Bulgarian National Cancer Registry, National Oncology Hospital, 6, Plovdivsko Pole Street, 1756 Sofia, Bulgaria.
| | - Anna Demetriou
- Cyprus Cancer Registry-Health Monitoring Unit, Ministry of Health, 1 Prodromou Street & 17 Chilonos Street, 1448 Lefkosia, Cyprus.
| | - Chakameh Safaei Diba
- National Cancer Registry of Slovakia, National Health Information Center, Lazaretska 26, 81109 Bratislava, Slovakia.
| | - Sultan Eser
- Hacettepe University, Public Health Institute, Sıhhıye Campus, Sıhhıye, 06100 Ankara, Turkey; Izmir Cancer Registry, Izmir Public Health Directorate, Zubeyde Hanim Caddesi No:100, 35067 Karsiyaka, Izmir, Turkey.
| | - Zivana Gavric
- Cancer Registry of Republic of Srpska, The Public Health Institute Banja Luka, Jovan Ducic 1, 78 000 Banja Luka, Bosnia and Herzegovina.
| | - Maja Primic-Zakelj
- Cancer Registry of Republic of Slovenia, Oncology Institute of Oncology Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia.
| | - Snezana Zivkovic
- Cancer Registry of Central Serbia, Institute of Public Health of Serbia, Dr Subotica 5, 11000 Belgrade, Serbia.
| | - Miroslav Zvolsky
- Czech National Cancer Registry, Institute of Health Information and Statistics of the Czech Republic, Palackého nám. 4, PO Box 60, 128 01 Praha 2, Czech Republic.
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 CEDEX 08 Lyon, France.
| | - Jan Willem Coebergh
- Department of Public Health, Erasmus University Medical Center, PO Box 2040 3000 CA Rotterdam, The Netherlands.
| | - Ariana Znaor
- Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 CEDEX 08 Lyon, France.
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Crocetti E, Mallone S, Robsahm TE, Gavin A, Agius D, Ardanaz E, Lopez MDC, Innos K, Minicozzi P, Borgognoni L, Pierannunzio D, Eisemann N. Survival of patients with skin melanoma in Europe increases further: Results of the EUROCARE-5 study. Eur J Cancer 2015; 51:2179-2190. [PMID: 26421821 DOI: 10.1016/j.ejca.2015.07.039] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/08/2015] [Accepted: 07/20/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND In Europe skin melanoma (SM) survival has increased over time. The aims were to evaluate recent trends and differences between countries and regions of Europe. METHODS Relative survival (RS) estimates and geographical comparisons were based on 241,485 patients aged 15years and over with a diagnosis of invasive SM in Europe (2000-2007). Survival time trends during 1999-2007 were estimated using the period approach, for 213,101 patients. Age, gender, sub-sites and morphology subgroups were considered. RESULTS In European patients, estimated 5-year RS was 83% (95% confidence interval, CI 83-84%). The highest values were found for patients resident in Northern (88%; 87-88%) and Central (88%; 87-88%) Europe, followed by Ireland and United Kingdom (UK) (86%; 85-86%) and Southern Europe (83%; 82-83%). The lowest survival was in Eastern Europe (74%; 74-75%). Within regions the intercountry absolute difference in percentage points of RS varied from 4% (North) to 34% (East). RS decreased markedly with patients' age and was higher in women than men. Differences according to SM morphology and skin sub-sites also emerged. Survival has slightly increased from 1999 to 2007, with a small improvement in Northern and the most pronounced improvement in Eastern Europe. DISCUSSION SM survival is high and still increasing in European patients. The gap between Northern and Southern and especially Eastern European countries, although still present, diminished over time. Differences in stage distribution at diagnosis may explain most of the geographical differences. However, part of the improvement in survival may be attributed to overdiagnosis from early diagnosis practices.
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Affiliation(s)
- Emanuele Crocetti
- UO Epidemiologia Clinica, Descrittiva e Registri - ISPO, Firenze, Italy.
| | - Sandra Mallone
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma, Italy
| | - Trude Eid Robsahm
- Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queens University, Belfast, Northern Ireland, UK
| | - Domenic Agius
- Malta National Cancer Registry, Department of Health Information and Research, Pieta, Malta
| | - Eva Ardanaz
- Navarra Cancer Registry, Navarra Public Health Institute, Pamplona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Maria-Dolores Chirlaque Lopez
- Servicio de Epidemiología, Department of Epidemiology, Consejería de Sanidad, Murcia Health Authority, Murcia, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Kaire Innos
- Department of Epidemiology and Biostatistics National, Institute for Health Development, Tallinn, Estonia
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lorenzo Borgognoni
- SC Chirurgia Plastica e Ricostruttiva, Ospedale S.M. Annunziata - Azienda Sanitaria di Firenze Centro di Riferimento Regionale per il Melanoma, Istituto Toscano Tumori, Firenze, Italy
| | - Daniela Pierannunzio
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma, Italy
| | - Nora Eisemann
- Institute of Cancer Epidemiology, University of Luebeck, Luebeck, Germany
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Similar anatomical distributions of childhood naevi and cutaneous melanoma in young adults residing in northern and southern Sweden. Eur J Cancer 2015; 51:2067-75. [DOI: 10.1016/j.ejca.2015.06.114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 06/14/2015] [Accepted: 06/23/2015] [Indexed: 11/23/2022]
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Abstract
The association between various measures of sun exposure and melanoma risk is quite complex to dissect as many case-control studies of melanoma included different subtypes of melanomas which are likely to be biologically different, so interpretation of the data is difficult. Screening bias in countries with high levels of sun exposure is also an issue. Now that progress is being made in the genetic subclassification of melanoma tumours, it is apparent that melanomas have different somatic changes according to body sites/histological subtypes and that UV exposure may be relevant for some but not all types of melanomas. Melanoma behaviour also points to non-sun-related risk factors, and complex gene-environment interactions are likely. As UV exposure is the only environmental factor ever linked to melanoma, it is still prudent to avoid excessive sun exposure and sunburn especially in poor tanners. However, the impact of strict sun avoidance, which should not be recommended, may take years to be apparent as vitamin D deficiency is a now a common health issue in Caucasian populations, with a significant impact on health in general.
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Affiliation(s)
- Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, King's College, London, UK,
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Serrano MA, Cañada J, Moreno JC. Solar UV exposure in construction workers in Valencia, Spain. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2013; 23:525-530. [PMID: 22739681 DOI: 10.1038/jes.2012.58] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 03/29/2012] [Indexed: 06/01/2023]
Abstract
Exposure to ultraviolet radiation (UVR) has long been recognized as the most important environmental risk factor for melanoma and skin cancer. Outdoor workers are among the groups most at risk from exposure to solar UVR in their daily activities. Sensitive spore-film filter-type personal dosimeters (VioSpor) were used to measure the biologically effective UVR received by construction workers in the course of their daily work. The study took place in Valencia, Spain, in July 2010 and involved a group of eight workers for a period of 5 days. The median UV exposure was 6.11 standard erythema dose (SED) per day, with 1 SED defined as effective 100 J/m(2) when weighted with the Commission Internationale de L'Eeclairage erythemal response function. These workers were found to receive a median of 13.9% of total daily ambient ultraviolet erythemal radiation (UVER). Comparison with the occupational UVR exposure limit showed that the subjects had received UVER exposure in excess of occupational guidelines, indicating that protective measures against this risk are highly advisable.
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Affiliation(s)
- María-Antonia Serrano
- Instituto de Ingeniería Energética, Universitat Politècnica de València, 46022 Valencia, España.
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Bataille V. Melanoma. Shall we move away from the sun and focus more on embryogenesis, body weight and longevity? Med Hypotheses 2013; 81:846-50. [PMID: 23796690 PMCID: PMC3828598 DOI: 10.1016/j.mehy.2013.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 05/16/2013] [Accepted: 05/23/2013] [Indexed: 12/20/2022]
Abstract
There are many observations regarding the behaviour of melanoma which points away from sunshine as the main cause of this tumour. Incidence data shows that the increase is mostly seen for thin melanomas which cannot be attributed to sun exposure but increasing screening over the last 20 years. Melanoma behaves in a similar fashion all over the world regarding age of onset, gender differences and histological subtypes. An excess of naevi is the strongest risk factor for melanoma and their appearance and involution throughout life, and the differences in naevus distribution according to gender is giving us a lot of clues about melanoma biology. Melanoma like all cancers is a complex disease with the involvement of many common and low penetrance genes many of them involved in pigmentation and naevogenesis but these only explain a very small portion of melanoma susceptibility. Genes involved in melanocyte differentiation early on in embryogenesis are also becoming relevant for melanoma initiation and progression. Reduced senescence and longevity as well as body weight and energy expenditure are also relevant for melanoma susceptibility. These observations with links between melanoma and non-sun related phenotypes as well as gene discoveries should help to assess the relative contribution of genetic and environmental factors in its causation.
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Affiliation(s)
- Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, St. Thomas Hospital, Kings College, London, UK; Dermatology Department, Hemel Hempstead General Hospital, West Herts NHS Trust, Herts, UK.
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Kandolf-Sekulović L, Zivković-Perišić S, Radević T, Rajović M, Dinić M, Zolotarevski L, Mijušković Z, Zečević RD, Novaković M. Melanoma in South-East Europe: epidemiological data from the central cancer registry and clinicopathological characteristics from the hospital-based registry in Serbia. Int J Dermatol 2013; 51:1186-94. [PMID: 22994665 DOI: 10.1111/j.1365-4632.2012.05518.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Lidija Kandolf-Sekulović
- Department of Dermatology, Military Medical Academy, Cancer Registry of Central Serbia, Belgrade, Serbia.
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Ali SM, Bonnier F, Ptasinski K, Lambkin H, Flynn K, Lyng FM, Byrne HJ. Raman spectroscopic mapping for the analysis of solar radiation induced skin damage. Analyst 2013; 138:3946-56. [DOI: 10.1039/c3an36617k] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Forsea AM, Del Marmol V, de Vries E, Bailey EE, Geller AC. Melanoma incidence and mortality in Europe: new estimates, persistent disparities. Br J Dermatol 2012; 167:1124-30. [PMID: 22759278 DOI: 10.1111/j.1365-2133.2012.11125.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Melanoma incidence and mortality in Europe are high but there are significant gaps in the epidemiological information available across the continent. OBJECTIVES With the aim of enhancing the planning of educational programmes for reducing the melanoma burden in Europe, we analysed the most recent incidence and mortality data for Europe with a new focus on the regional disparities of melanoma reporting. METHODS GLOBOCAN 2008, the standard set of worldwide estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer for 2008, was used to provide the estimated age-standardized rates (world standard population) of melanoma incidence and mortality in European countries and regions. RESULTS The estimated age-standardized incidence of melanoma (measured per 100 000 person-years) varies widely from 19·2 in Switzerland to 2·2 in Greece. The incidence rate of 4·3 of Central and Eastern Europe (CEE) is less than half of that of Western Europe. Melanoma mortality rates of 1·5 are similar in CEE and Western Europe, although rates vary with a high of 3·2 in Norway and a low of 0·9 in Greece. Over 20 000 deaths from melanoma were estimated in Europe in 2008, with CEE having the largest share (35·5%) among the four geographical European regions. Population-based data are lacking for significant parts of CEE, which must rely on estimates. CONCLUSIONS The most recent estimates of melanoma incidence and mortality in Europe reveal sharp differences between European countries, possibly related to missed opportunities for early diagnosis and incomplete reporting of melanoma in Eastern Europe.
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Affiliation(s)
- A M Forsea
- Department of Society, Human Development and Health, Harvard School of Public Health, Kresge Building, Room 718, 677 Huntington Avenue, Boston, MA 02115, USA.
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13
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Trakatelli M, Siskou S, Proby C, Tiplica G, Hinrichs B, Altsitsiadis E, Kitsou A, Ferrandiz L, Aquilina S, Apap C, Ulrich M, Fiorentini C, Magnoni C, de Vries E, Flohil S, Kalokasidis K, Moreno-Ramirez D, Ruiz-de-Casas A, Majewski S, Ranki A, Pitkänen S, Saksela O, Ioannides D, Sotiriadis D, Stockfleth E. The patient journey: a report of skin cancer care across Europe. Br J Dermatol 2012; 167 Suppl 2:43-52. [DOI: 10.1111/j.1365-2133.2012.11086.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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van der Leest RJT, de Vries E, Bulliard JL, Paoli J, Peris K, Stratigos AJ, Trakatelli M, Maselis TJEML, Situm M, Pallouras AC, Hercogova J, Zafirovik Z, Reusch M, Olah J, Bylaite M, Dittmar HC, Scerri L, Correia O, Medenica L, Bartenjev I, Guillen C, Cozzio A, Bogomolets OV, del Marmol V. The Euromelanoma skin cancer prevention campaign in Europe: characteristics and results of 2009 and 2010. J Eur Acad Dermatol Venereol 2011; 25:1455-65. [PMID: 21951235 DOI: 10.1111/j.1468-3083.2011.04228.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Euromelanoma is a skin cancer education and prevention campaign that started in 1999 in Belgium as 'Melanoma day'. Since 2000, it is active in a large and growing number of European countries under the name Euromelanoma. OBJECTIVE To evaluate results of Euromelanoma in 2009 and 2010 in 20 countries, describing characteristics of screenees, rates of clinically suspicious lesions for skin cancer and detection rates of melanomas. METHODS Euromelanoma questionnaires were used by 20 countries providing their data in a standardized database (Belgium, Croatia, Cyprus, Czech Republic, FYRO Macedonia, Germany, Greece, Hungary, Italy, Lithuania, Luxembourg, Malta, Moldavia, Portugal, Serbia, Slovenia, Spain, Sweden, Switzerland and Ukraine). RESULTS In total, 59,858 subjects were screened in 20 countries. Most screenees were female (64%), median ages were 43 (female) and 46 (male) and 33% had phototype I or II. The suspicion rates ranged from 1.1% to 19.4% for melanoma (average 2.8%), from 0.0% to 10.7% for basal cell carcinoma (average 3.1%) and from 0.0% to 1.8% for squamous cell carcinoma (average 0.4%). The overall positive predictive value of countries where (estimation of) positive predictive value could be determined was 13.0%, melanoma detection rates varied from 0.1% to 1.9%. Dermoscopy was used in 78% of examinations with clinically suspected melanoma; full body skin examination was performed in 72% of the screenees. CONCLUSION Although the population screened during Euromelanoma was relatively young, high rates of clinically suspected melanoma were found. The efficacy of Euromelanoma could be improved by targeting high-risk populations and by better use of dermoscopy and full body skin examination.
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Affiliation(s)
- R J T van der Leest
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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15
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Baade P, Meng X, Youlden D, Aitken J, Youl P. Time trends and latitudinal differences in melanoma thickness distribution in Australia, 1990-2006. Int J Cancer 2011; 130:170-8. [PMID: 21344376 DOI: 10.1002/ijc.25996] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 02/02/2011] [Indexed: 11/08/2022]
Abstract
This study investigated time trends and latitude differentials in the thickness distributions of invasive melanomas diagnosed in Australia between 1990 and 2006 using data from population-based cancer registries. Trends in incidence rates were calculated by sex, age group, thickness, year at diagnosis and latitude. For thin (<1.00 mm) melanomas the increase was very pronounced during the early 1990s (1990-1996, annual percentage change and 95% confidence interval: males +5.6(+3.5,+7.7); females +4.1(+1.7,+6.5), but then incidence rates became stable among both males (+0.6(-0.1,+1.4)) and females (-0.0(-0.9,+0.9)) of all ages between 1996 and 2006. In contrast, incidence of thick (>4.00 mm) melanomas continued to increase over the entire period (males +2.6(+1.9,+3.4); females +1.6(+0.6,+2.6)). Recent reductions in the incidence of thin melanomas were observed among young (<50 years) males and females, contrasted by an increase in thin melanomas among older people, and increases in thick melanomas among most age groups for males and elderly (75+) females. A strong latitude gradient in incidence rates was observed, with rates being highest in northern, more tropical areas and lowest in the most southern regions. However, the magnitude of the increase in thick melanomas was most pronounced in southern parts of Australia. The observed trends in thin melanomas can most likely be attributed to the impact of early detection and skin awareness campaigns. However, these efforts have not impacted on the continued increase in the incidence of thick melanomas, although some increase may be due to earlier detection of metastasising melanomas. This highlights the need for continued vigilance in early detection processes.
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Affiliation(s)
- Peter Baade
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, Australia; School of Public Health, Queensland University of Technology, Brisbane, Australia.
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Kvaskoff M, Weinstein P. Are some melanomas caused by artificial light? Med Hypotheses 2010; 75:305-11. [DOI: 10.1016/j.mehy.2010.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 03/07/2010] [Indexed: 10/19/2022]
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Lipsker D, Engel F, Cribier B, Velten M, Hedelin G. Trends in melanoma epidemiology suggest three different types of melanoma. Br J Dermatol 2007; 157:338-43. [PMID: 17596175 DOI: 10.1111/j.1365-2133.2007.08029.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND It has been suggested that the incidence of thin melanomas but not of thick tumours is rising in fair-skinned populations, although the reason for this discrepancy is not understood. OBJECTIVES To describe temporal trends in melanoma epidemiology in a limited part of France in order to confirm this observation and to provide an explanation. METHODS This is a retrospective population- and academic centre-based study in which all melanomas diagnosed in the department of the Bas-Rhin, France between January 1980 and December 2004 were included. RESULTS The study included 2094 melanomas diagnosed in 2020 patients. There was a steady increase in incidence of thin (< 1 mm) melanomas, mainly located on the trunk, and to a lesser extent in the head and neck region, in both sexes, and of intermediate (1-2 mm) melanomas in men. The incidence of intermediate melanomas in women and of thick (> 2 mm) melanomas, as well as mortality related to melanoma, remained stable. There was a steady decline of mean and median Breslow thickness. The 12 months median delay to diagnosis of thick tumours was significantly shorter than the 24 months delay to diagnosis of thin tumours. CONCLUSIONS Temporal trends suggest the existence of three unrelated types of melanoma: type I, thick melanomas, with stable incidence; type II, thin melanoma with a steady and important increase in incidence, mainly located on the trunk; and type III, melanoma with a slower increase in incidence, mainly located on the head and neck region.
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Affiliation(s)
- D Lipsker
- Clinique Dermatologique, Faculté de Médecine, Université Louis Pasteur, 1 place de l'hôpital, F-67091 Strasbourg cedex, France.
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Stratigos A, Nikolaou V, Kedicoglou S, Antoniou C, Stefanaki I, Haidemenos G, Katsambas AD. Melanoma/skin cancer screening in a Mediterranean country: results of the Euromelanoma Screening Day Campaign in Greece. J Eur Acad Dermatol Venereol 2007; 21:56-62. [PMID: 17207168 DOI: 10.1111/j.1468-3083.2006.01865.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Since the year 2000 a melanoma/skin cancer screening campaign has been organized annually in Greece in the context of the Euromelanoma Screening Day Campaign. OBJECTIVES We aimed to analyse the characteristics of the screened population, to recognize relevant risk factors and to identify the cases of histologically confirmed malignant melanoma (MM) in individuals with suspicious skin lesions. METHODS An analysis of the completed screening forms from the years 2000-2004 was performed with respect to relevant demographic, epidemiological and clinical data. RESULTS A total of 9723 individuals were screened, most of whom where below the age of 50 years (71%), female (59%), and of skin phototype II and III (76%). Sunburn during childhood was reported in 47% of participants, while 5% of the screened population had a personal or family history of melanoma. On clinical examination, 14.4% had actinic keratoses, 31.2% had dysplastic nevi, while 6.4% carried a presumptive diagnosis of non-melanoma skin cancer. In the 2003-2004 screening campaign, 19 out of the 171 clinically suspicious lesions were histologically proven to be MM, the majority of which (58%) were 'thin' melanomas (Breslow's thickness of<or=1 mm) of the superficial spreading type. CONCLUSIONS Our study suggested that, a melanoma/skin cancer screening programme in a Mediterranean country, supported by an intense publicity campaign, attracted many individuals at risk for skin cancer and detected mostly thin melanomas of the superficial spreading type.
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Affiliation(s)
- A Stratigos
- Department of Dermatology, University of Athens Medical School, Andreas Sygros Hospital, Athens, Greece.
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de Vries E, Steliarova-Foucher E, Spatz A, Ardanaz E, Eggermont AMM, Coebergh JWW. Skin cancer incidence and survival in European children and adolescents (1978–1997). Report from the Automated Childhood Cancer Information System project. Eur J Cancer 2006; 42:2170-82. [PMID: 16919779 DOI: 10.1016/j.ejca.2006.07.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patterns and trends of melanoma and skin carcinoma incidence and survival of European children (age 0-14 years) and adolescents (age 15-19 years) were investigated. Between 1978 and 1997, a total of 1419 melanoma and 485 skin carcinoma cases were recorded in the cancer registries contributing to the Automated Childhood Cancer Information System (ACCIS) study. During 1988-1997, the incidence of melanoma was 0.7 per million children and 12.9 per million adolescents; corresponding rates for skin carcinomas were 0.3 and 3.7 per million, respectively. The British Isles had the highest incidence of skin cancers in children and adolescents. For Europe, in adolescents melanomas were more common in the North and West, skin carcinomas in the South and East. Between 1978 and 1997 incidence increased annually in adolescents, by 4.1% for melanoma and 2.5% for skin carcinoma. Differences in aetiology between childhood and adolescent skin cancers cannot be excluded. Survival was relatively high and the geographical variations in incidence and survival seem to be associated.
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Affiliation(s)
- E de Vries
- Department of Public Health, Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
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Stang A, Valiukeviciene S, Aleknaviciene B, Kurtinaitis J. Time trends of incidence, mortality, and relative survival of invasive skin melanoma in Lithuania. Eur J Cancer 2006; 42:660-7. [PMID: 16510281 DOI: 10.1016/j.ejca.2005.11.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Accepted: 11/14/2005] [Indexed: 10/25/2022]
Abstract
The aim of this study was to provide insights into the descriptive epidemiology of invasive skin melanoma in Lithuania by analyzing population-based incidence (1978-2002) and mortality (1990-2002) time trends, and relative survival based on 3485 skin melanoma. We calculated age-standardized incidence and mortality rates (cases per 100,000) using the European Standard Population and calculated period estimates of relative survival. The incidence rates increased from 1978 (men: 1.7, women: 2.3) to 2002 (men: 5.0, women: 7.0). The incidence increase over time is accompanied by cohort effects among both men and women. Mortality rates increased from 1990 (men: 1.2, women: 1.7) to 2002 (men: 2.3, women: 2.2). Relative 5-year survival rates among men were 10% lower than among women. The overall difference in survival was mainly due to a more favourable survival among women aged 60-74 years. Overall prognosis was less favourable among men, most likely due to diagnoses at later stages.
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Affiliation(s)
- Andreas Stang
- Clinical Epidemiology Unit, Institute of Medical Epidemiology, Biometry and Informatics, University Hospital, University of Halle, Magdeburger Str. 27, 06109 Halle, Germany.
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Abstract
INTRODUCTION The incidence of melanoma and the resulting mortality have been the subject of many studies. However, controversy remains as to the interpretation of the number of cases observed and the existence of an actual "epidemic" of melanomas in fair-skinned populations. OBJECTIVES Analyze the descriptive epidemiological data available concerning cutaneous melanomas in France and in Europe. METHODS Data regarding incidence and mortality published in the literature and on the Internet were reviewed and analyzed. RESULTS In France, between 1980 and 2000, the standardized worldwide population incidence rate of melanoma increased from 2.4 to 7.6 per 100.000 inhabitants/years in men and from 3.9 to 9.5 in women. In the Haut-Rhin department in France, where Breslow indexes are registered, the increase in incidence was accompanied by an increase in the proportion of thin melanomas. In the year 2000, the estimated number of new cases of cutaneous melanomas was of 7231, with 58 p. 100 female and 42 p. 100 male cases. Great geographical disparity among the 9 departments in France equipped with registers was noted. This increase in incidence was accompanied by an increase in mortality. Between 1969 and 1997, mortality due to melanoma was multiplied by 2.7 in women and by 2.9 in men. In the year 2000, 1364 deaths were attributed to a melanoma. The standardized worldwide mortality rates were of 1.6/100000 inhabitants/years in men and 1.1/100000 inhabitants/years in women. In Europe, a great increase in the incidence and mortality has been registered in all countries since the nineteen fifties. It was earlier and greater in northern European countries, followed by western European countries, and finally by eastern and southern countries. There was great geographical disparity, with a double decreasing North-South East-West gradient. Analysis of the recent trends in development, in countries with high incidence such as those of northern Europe, showed a trend towards the stabilization in the incidence and decreased mortality in young adults. DISCUSSION In France, as in Europe, the extensive increase in incidence of melanoma and resulting mortality is a reality, reaching a peak in the northern European countries. The decrease in mortality observed recently in young cohorts in these countries and in Eastern Europe may announce an ultimate decrease in the older populations and the rest of Europe. Massive primary and secondary prevention campaigns seem effective and warrant reinforcement.
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Affiliation(s)
- F Grange
- Service de Dermatologie, Hôpital Robert Debré, Reims.
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Affiliation(s)
- V Bataille
- Dermatology Department, West Herts NHS Trust, Hemel Hempstead General Hospital, Hillfield Road, Herts HP2 4AD, Angleterre.
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Boniol M, De Vries E, Coebergh JW, Doré JF. Seasonal variation in the occurrence of cutaneous melanoma in Europe: influence of latitude. An analysis using the EUROCARE group of registries. Eur J Cancer 2005; 41:126-32. [PMID: 15617997 DOI: 10.1016/j.ejca.2004.09.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Revised: 08/31/2004] [Accepted: 09/08/2004] [Indexed: 10/26/2022]
Abstract
The aim of our study was to analyse seasonal variations in melanoma incidence in Europe. Data from 28117 cutaneous melanoma cases reported during 1978-1993 to the EUROCARE group of registries were analysed. There is a clear summer peak in incidence in Western countries (summer-winter ratio: 1.31 P < 0.0001; Nam's test), which was not observed in Central Europe (ratio: 1.06; P = 0.0699). The amplitude of seasonality is higher for females (ratio = 1.38, 95% Confidence Interval (CI) [1.31-1.44]) than for males (ratio = 1.21 95%CI [1.14-1.29]). It is also higher for upper and lower limbs (1.44 and 1.46, respectively), than for head and neck or trunk regions (1.09 and 1.20, respectively). The amplitude of seasonality also varies with latitude and increases with time: in a linear regression adjusting for age, gender and anatomical localisation, the date of diagnosis was significantly closer to summer solstice with decreasing latitude (P = 0.0005) and for more recent year of diagnosis (P = 0.0123). The effect of latitude on the amplitude of the seasonal variation in melanoma incidence in Europe may be an indicator of ultraviolet B (UVB) exposure. Furthermore, an increase in intentional sun exposure could lead to an increase in melanoma promotion and thus to an increase in the amplitude of seasonal variation.
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Affiliation(s)
- Mathieu Boniol
- INSERM Unit 590, Centre Léon Bérard, 28 Rue Laennec, 69373, Lyon, Cedex 08, France.
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de Vries E, Coebergh JW. Cutaneous malignant melanoma in Europe. Eur J Cancer 2004; 40:2355-66. [PMID: 15519506 DOI: 10.1016/j.ejca.2004.06.003] [Citation(s) in RCA: 195] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Accepted: 05/12/2004] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Esther de Vries
- Erasmus Medical Centre, Department of Public Health, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
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de Vries E, Bray FI, Eggermont AMM, Coebergh JWW. Monitoring stage-specific trends in melanoma incidence across Europe reveals the need for more complete information on diagnostic characteristics. Eur J Cancer Prev 2004; 13:387-95. [PMID: 15452451 DOI: 10.1097/00008469-200410000-00006] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cutaneous malignant melanoma has been characterized by rapid and steady increases in incidence and mortality in white populations. Some reports mentioned declining trends in the mean thickness of these tumours, but other studies suggested a stable incidence of thick melanomas. The aim of this study was to describe the stage distribution of melanomas across Europe, with particular reference to temporal trends. Twenty-three cancer registries provided data sets containing information on stage and histology, 21 of which were used for a general description and nine for trends analyses. Despite a preponderance of missing data, interesting patterns emerged: a less favourable stage distribution in populations with relatively low incidence, but high case-fatality rates, and a favourable trend in stage and histology distribution over time, including a shift from later to earlier stages in recent years. Early detection campaigns raising awareness for thin lesions can potentially improve melanoma survival rates. Monitoring of stage-specific trends in melanoma incidence can assess the impact of such interventions. This paper demonstrates the potential utility of high-quality, timely cancer registry data in pursuing such public health objectives and addresses the need for more complete information on diagnostic features of melanoma patients. This will allow more informative evaluations of preventive strategies.
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Affiliation(s)
- E de Vries
- Unit of Descriptive Epidemiology, International Agency for Research on Cancer, Lyon, France.
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