Population-based study of cutaneous malignant melanoma in the Granada province (Spain), 1985-1992

Epidemiological and clinical characterization of a population-based cohort of cutaneous malignant melanoma patients in the South Region of Portugal

An historical population-based cohort study was conducted aiming to estimate the incidence of cutaneous malignant melanoma in the South Region of Portugal between Jan 2016 and June 2017; to clinically characterize the diagnosed individuals; to describe instituted treatment; and to estimate survival outcomes. Data were extracted from a cancer registry (ROR-Sul) covering 4,800,000 inhabitants (46% of the Portuguese population) and included a total of 789 individuals meeting eligibility criteria. The crude incidence rate (18 months) of melanoma was 13.36/100,000 inhabitants and the Age-Standardized Incidence Rate per 100,000 World population was 9.65/100,000 inhabitants. The most common histological subtypes identified were superficial extension, followed by malignant melanoma and nodular melanoma. Most cases were diagnosed in stage I (50.39%), equally distributed by sex and with a median age of 65 years. During the study period, 174 recurrence events were recorded (23.45%) and recurrence-free survival rate was significantly lower in more advanced stages. Patients had a two-fold risk of recurrence/death when in presence of ulcerated tumors [adjusted hazard ratio (adj HR) = 2.28; 95% confidence interval (CI) 1.40-3.70]. Overall survival rate at 3-years was 80.54% (95% CI 77.58-83.15), higher than previous national reports, and considerably higher for individuals diagnosed at earlier stages (p < 0.001). We have also identified differential survival outcomes in stages II-III explained by the uptake of sentinel lymph node biopsy. The epidemiologic and clinical characteristics of malignant melanoma patients studied are consistent with international literature. The incidence and rates observed suggests additional public health campaigns are needed to modify behaviours of the Portuguese population and thus reduce their risk.

Skin Cancer Incidence and Mortality in Spain: A Systematic Review and Meta-Analysis

INTRODUCTION AND OBJECTIVES

The aim of this systematic review was to describe the incidence and mortality of basal cell carcinoma, squamous cell carcinoma, melanoma, and Merkel cell carcinoma in Spain.

MATERIAL AND METHODS

We performed a search of the MEDLINE and Embase databases and reviewed articles from the Spanish Network of Cancer Registries (REDECAN) and the International Agency for Research on Cancer (IARC). The methodological quality of the studies was evaluated and statistical heterogeneity was measured using the I(2) index. A random-effects model was used to perform the meta-analysis because of the heterogeneity of the data.

RESULTS

Thirty-two papers were included in the systematic review. The crude incidence rate for basal cell carcinoma was 113.05 (95% CI, 89.03-137.08) cases per 100 000 person-years for the studies based on the registration methodology normally used by registries (in which only 1 tumor with histological confirmation is counted per person). However, the same incidence rate calculated on the basis of clinical and histologic criteria and counting tumors rather than individual patients was 253.23 (95% CI, 273.01-269.45) cases per 100 000 person-years. The incidence was 38.16 (95% CI, 31.72-39.97) cases per 100 000 person-years for squamous cell carcinoma, 8.76 (95% CI, 7.50-10.02) cases per 100 000 person-years for melanoma, and 0.28 (95% CI, 0.15-0.40) cases per 100 000 person-years for Merkel cell carcinoma.

CONCLUSIONS

The registration methodology normally used by cancer registries probably underestimates the incidence rates of basal cell and squamous cell carcinoma in Spain. The incidence rates of cutaneous melanoma and Merkel cell carcinoma are lower in Spain than in other European countries.

Melanoma characteristics at diagnosis from the Spanish National Cutaneous Melanoma Registry: 15 years of experience

BACKGROUND AND OBJECTIVES

The Spanish National Cutaneous Melanoma Registry (Registro Nacional de Melanoma Cutáneo [RNMC]) was created in 1997 to record the characteristics of melanoma at diagnosis. In this article, we describe the characteristics of these tumors at diagnosis.

PATIENTS AND METHODS

This was a cross-sectional observational study of prevalent and incident cases of melanoma for which initial biopsy results were available in the population-based RNMC.

RESULTS

The RNMC contains information on 14,039 patients. We analyzed the characteristics of 13,628 melanomas diagnosed between 1997 and 2011. In total, 56.5% of the patients studied were women and 43.5% were men. The mean age of the group was 57 years (95% CI, 56.4-57 years) while median age was 58 years. The most common tumor site was the trunk (37.1%), followed by the lower limbs (27.3%). The most frequent clinical-pathologic subtype was superficial spreading melanoma (n=7481, 62.6%), followed by nodular melanoma (n=2014, 16.8%). Localized disease was observed in 86.2% of cases (n=10,382), regional metastasis in 9.9% (n=1188), and distant metastasis in 3.9% (n=479). Independently of age at diagnosis, men had thicker tumors, more ulceration, higher lactate dehydrogenase levels, and a higher rate of metastasis than women (P<.001).

CONCLUSIONS

Based on our findings, melanoma prevention campaigns should primarily target men over 50 years old because they tend to develop thicker tumors and therefore have a worse prognosis.

The needs and experiences of people with a diagnosis of skin cancer: a systematic review

EXECUTIVE SUMMARY

Background Skin cancer is the most common cancer in Caucasians and the incidence is increasing worldwide. There has been no qualitative systematic review looking at the needs and experiences of patients through the skin cancer journey.Objectives The main objective of this systematic review was to identify, appraise and synthesise the literature relating to the needs and experiences of people with a diagnosis of skin cancer.

INCLUSION CRITERIA

Adults with a diagnosis of skin cancer.The needs and experiences of people with skin cancer.All qualitative studies that described or analysed the needs and experiences with people who had been diagnosed with skin cancer.Search strategy The search strategy sought to identify both published and unpublished research studies. A three step search strategy was used, limited to English language papers.Methodological quality Each paper was independently assessed by two independent reviewers for methodological quality, using the critical appraisal instrument from Joanna Briggs Institute Qualitative Assessment of Review Instrument (QARI), prior to inclusion in the review.Data collection The standardised data extraction tool from JBI-QARI was used to extract data from the papers.Data synthesis The qualitative research findings were pooled using JBI-QARI approach. This involved the aggregation of findings.Results Only two studies were included. The 12 findings were grouped according to their similarities of meaning to form 4 categories. These four categories resulted in two synthesised findings. The diagnosis of skin cancer produces a range of emotional responses in individuals. Individuals also delay seeking medical help however once treated are satisfied with care.Conclusions There is very little good research on patient's experiences and needs of skin cancer. People require support in coming to terms with the diagnosis and there is a need for an educational intervention of some form to prevent delay in seeking medical help.Implications for practice There is a real need to increase knowledge of skin cancer so that people do not delay in seeking medical help as early diagnosis can dramatically improve both prognosis and the patient experience since early lesions are treated more simply compared with larger or neglected lesions. Health professionals caring for these patients need to understand the psychosocial concerns of this patient group in order to design services appropriately and to provide patients with the support they need and information that they can easily understand.Implications for research Results from this review have identified that the needs and experiences of individuals with skin cancer remains under-researched and this has implications for those caring for and delivering services to this group of patients. There are very few studies considering this aspect of patients' experiences and therefore a real need to conduct further research into the needs and experience of skin cancer patients.

Cutaneous melanoma in the elderly: epidemiology, prognosis and treatment

The incidence and mortality of cutaneous melanoma (CM) has increased over the last decades in fair-skinned populations. Incidence and mortality, as well as rates of increase, have been significantly higher in elderly people compared with younger age groups. Lower survival rates from CM among elderly are mainly the result of late diagnosis of tumors with dismal prognostic features. Expansion of current preventive strategies to include older age groups is therefore warranted. Despite differences in clinical presentation and pathological characteristics of CM in the elderly, there is no evidence that primary surgical treatment should differ from that proposed generally for melanoma. However, the rate of positive sentinel node dissection decreases with age, even though overall survival is shorter in older patients, a paradox that remains to be explained. The use of adjuvant treatment with interferon-alpha in elderly patients requires careful discussion of the risks and benefits, especially when serious illness coexists. For metastatic melanoma, complete metastasectomy is the only treatment associated with benefit for overall survival. However, careful selection of surgical oncogeriatric candidates is necessary, probably with the use of tools to provide a comprehensive geriatric assessment, to identify patients more likely to benefit from this treatment. In the absence of any effective systemic treatment for disseminated CM, new therapeutic agents are urgently needed. Practical means to improve accrual of older patients in clinical trials are necessary to provide better evidence for their treatment.

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.

Clinical characteristics of cutaneous melanoma and second primary malignancies in a dutch hospital-based cohort of cutaneous melanoma patients

The increasing number of living cutaneous melanoma patients and the increased risk of developing a second primary tumour incited us to analyse the clinical characteristics of cutaneous melanoma and define the frequency, site, and type of second primary cancers in cutaneous melanoma patients. We collected data on patients who visited the Department of Dermatology at the Radboud University Nijmegen Medical Centre and were newly diagnosed with cutaneous melanoma or metastasis of melanoma with unknown primary localization between 2002 and 2006. A total of 194 cases were included; eleven patients developed a subsequent melanoma, 24 had at least one basal cell carcinoma, three had at least one squamous cell carcinoma, and 21 patients had a second non-cutaneous primary malignancy. In conclusion, 48 patients developed a subsequent malignancy. As nonmelanoma skin cancer is the most frequent second malignancy, our results subscribe to the necessity of follow-up by a dermatologist.

[Clinical-pathological features of cutaneous melanomas diagnosed in a Mediterranean tertiary hospital between 1990 and 2004: a comparison between sexes and age groups and analysis of longterm outcomes]

BACKGROUND

The incidence of malignant melanoma has increased over recent decades. Early diagnosis continues to be essential for effective treatment. Our objective was to analyze cutaneous malignant melanomas diagnosed over a 15-year period in a tertiary hospital for trends towards earlier diagnosis and to identify subgroups with poorer prognosis.

MATERIAL AND METHODS

Retrospective analysis of primary cutaneous melanomas analyzed in the pathology department of Hospital La Paz, Madrid, Spain, between 1990 and 2004.

RESULTS

In total, 526 melanomas were diagnosed. The mean (SD) Breslow thickness was 2.63 (4.84) mm and the median thickness was 0.98 mm (range, 0-65 mm). The mean size (widest point) was 16.59 (12.11) mm. The most common histological type was surface-spreading melanoma and the most common site was the trunk. Melanomas detected in men were generally larger and thicker than in women (P=0.05). Individuals aged over 60 years consulted for significantly thicker and larger tumors than younger individuals. The incidence of malignant melanomas has increased steadily over the years whereas the mean Breslow thickness and size have decreased.

CONCLUSIONS

Diagnosis of melanoma in Spain is made increasingly earlier, although locally advanced tumors are still sometimes seen in men and in individuals aged over 60 years.

Melanoma epidemiology and trends

Rising incidence rates of cutaneous melanoma have been observed during the last four decades in white populations worldwide. The cancer statistics in the United States have revealed 6 cases per 100,000 and year at the beginning of the 1970s and 18 cases per 100,000 inhabitants and year at the beginning of 2000, demonstrating a threefold increase in incidence rates. Incidence rates in central Europe increased in the same time period from 3 to 4 cases to 10 to 15 cases per 100,000 inhabitants and year, which is very similar to the increase in the United States. Cohort studies from several countries indicate that the trend of increasing incidence rates will continue in the future for at least the next 2 decades; thus, an additional doubling of incidence rates is expected. The highest incidence rates have been reported from Australia and New Zealand, from 40 to 60 cases per 100,000 inhabitants and year. Mortality rates likewise slightly increased in the United States and in Europe during the 1970s and 1980s. In the 1990 s, however, a leveling off of mortality rates was observed in many countries. Simultaneously, a clear decrease of Breslow tumor thickness was reported in the United States and European countries. This development indicates improved early recognition of cutaneous melanoma, which is presently the main factor for a more favorable prognosis.

Distribution of clinical-pathological types of cutaneous melanomas and mortality rate in the region of Passo Fundo, RS, Brazil

OBJECTIVE

To describe the characteristics of all cases of primary cutaneous melanoma during the period 1995-2001, registered at pathology departments in the region of Passo Fundo.

METHODS

The sample studied consisted of 229 primary cutaneous melanoma lesions, identified by anatomopathological reports, in 218 patients. The variables evaluated were: sex, age, anatomical site, histological type, level of invasion and tumor thickness. The rate of incidence, mortality and survival curve were calculated.

RESULTS

The most frequent tumor site was in the back of men (49.5%) and in the lower limbs of women (33.1%). The most frequent clinical-pathological type for both sexes was the superficial expansive type (superficial spreading) at 61.6%. The level of invasion was higher in men, using Clark level III (30.3%), than in women. In women the most frequent level of invasion was Clark level II (33.1%). Of the total number of lesions, 198 (47.2%) were </= 1 mm thick, and 23.2% of the men had thicker lesions (> 4 mm) than the women. The incidence was 5.67 per 100,000 patients-year during this period and the mortality rate was 2.16 per 100,000 patients-year.

CONCLUSIONS

In the sample studied the most common sites were in the back of men and in the legs of women. The predominant type clinical-pathological was superficial spreading.

Comprehensive evaluation of allele frequency differences of MC1R variants across populations

The melanocortin 1 receptor (MC1R), a member of the G protein-coupled receptors superfamily, mediates the response to melanocortins and is currently the best-described contributor to normal pigment variation in humans. A remarkably large number of natural polymorphisms, or variants, of the MC1R gene have been identified in different populations. Some of these variants have been associated with specific hair and skin color phenotypes, the presence of freckling, and melanoma and nonmelanoma skin cancer risk. Interestingly, some MC1R variants have been associated with skin cancer beyond their effects on pigmentation. Although the red hair color variants (RHC variants) have been associated with skin cancer risk in the Celtic population, studies in darkly-pigmented Caucasian populations have demonstrated the importance of non-RHC MC1R variants on skin cancer risk as well. We have reviewed and compared allele frequency differences of MC1R variants across geographic regions. We observed large differences in the distribution of variants across populations, with a prominent difference between lightly and darkly-pigmented individuals. Moreover, among Caucasian groups, there were seven variants (p.V60L, p.V92M, p.D84E, p.R151C, p.R160W, p.R163Q, and p.D294H) with significantly different allele frequencies. Exploring differences in allele frequencies of MC1R variants across populations with varying pigmentation and differing skin cancer risk may improve our understanding of the complex relationship between MC1R, pigmentation, and carcinogenesis.

Pathways to the development of melanoma: a complex issue

The investigation of nevus distribution by anatomic site has led to interesting hypotheses of divergent pathways to the development of melanoma. However, such hypotheses must be viewed in all their complexity, and the paper by Randi et al. gives additional substance to this complexity.

Epidemiología y supervivencia del melanoma cutáneo en España: estudio de 552 casos (1994-2003)

Studies on epidemiology and survival of patients diagnosed of cutaneous melanoma in our country are few. We described epidemiological, clinical, histopathologic and survival characteristics of patients diagnosed of cutaneous melanoma at Hospital Gregorio Marañón of Madrid during ten years (1994-2003). The incidence of melanoma has doubled in the last decade. An important proportion of melanomas continues to be diagnosed in advanced stages (III-IV; 14.5%). The following factors were associated with a poor global survival: Tumor thickness, ulceration, nodular type, masculine gender and age older than 65.

Malignant melanoma in Chile: an unusual distribution of primary sites in men from low socioeconomic strata

BACKGROUND

Mortality from malignant melanoma (MM) has increased in Chile in the past decade. The location of MM lesions on the body has been correlated with prognosis and survival.

AIM

To review body site and gender relationships with histopathologically confirmed primary MM in Chile.

METHODS

Records of 575 cases presenting to 5 state hospitals from 1992 to 2001 were analysed.

RESULTS

There were 360 women and 215 men. Women showed a significantly higher number of MM on the legs, cheeks and arms, and in the genital area, whereas men showed a significantly higher number on the ears, backs of the hands, soles and feet. Men had a predilection for MM with a poor prognosis.

CONCLUSION

The different body site distribution of primary MM in men and women may be explained by a different pattern of sun exposure. Ethnic and genetic factors may also be involved. The predominant location of MM in women in Chile is similar to white populations, whereas the location in men is similar to that observed in black and Asian populations. These observations may be relevant to the high mortality of MM in Chilean men.

Epidemiología del melanoma en España

Spain has one of Europe's lowest melanoma incidence and mortality rates. Nevertheless, it is one of the fastest-growing pathologies in our country, with a 181.3% increase in the incidence rate in men and 205.3% increase in women. It represents 1.3% and 2.5% of malignant tumors in men and women, respectively, while the current standardized worldwide rate is respectively 2.4% and 4.9%. The highest incidence levels correspond to Tarragona for men (6.81%) and Gerona for women (8.24%), and lowest to the Canary Islands and Zaragoza (3.55% and 4.27% for women and men, respectively). This higher incidence among females differentiates Spain from the rest of Europe, where the opposite occurs. Mortality has also increased in Spain in the last few decades (1.76% in males and 1.26% in females), although this rising trend has stabilized in recent years. Spain's mortality rate is the lowest in Europe, as the EUROCARE-III study revealed. This study found an increase of 70.4% in the survival rate for men and 84.1% for women in the 1980s, while the figures for the 1990s were 73.9% for men and 89.8% for women. This low mortality rate in Spain may be due to the increase in thin melanomas, due to early diagnosis and surgical treatment.

Has mortality from malignant melanoma stopped rising in Spain? Analysis of trends between 1975 and 2001

BACKGROUND

There have been suggestions that mortality from cutaneous malignant melanoma (CMM) is starting to level off in the European Union.

OBJECTIVES

To analyse changes in CMM mortality trends in Spain during 1975-2001 using joinpoint regression models.

METHODS

Mortality data were obtained from the National Statistics Institute. For each gender, age group-specific and standardized (overall and truncated) rates were calculated by the direct method (using the world standard population). The joinpoint analysis was used to identify the best-fitting points where a statistically significant change in the trend occurred.

RESULTS

In women, there was a marked increase from 1975 to 1994 in age-adjusted (overall and truncated) CMM mortality rates [estimated annual percentage change (EAPC) 6.6% and 7.0%, respectively; P < 0.05], followed by a levelling off (EAPC - 0.3% and - 1.3%, respectively; not significant). In men, age-adjusted (35-64 years) mortality rates increased steadily from 1975 to 1991 (EAPC 9.1%, P < 0.05) and then levelled off.

CONCLUSIONS

We confirmed that CMM mortality rates in Spain rose dramatically from the mid-1970s to the beginning of the 1990s, but we also found that mortality rates are now levelling off in middle-aged adults (35-64 years), following a similar tendency to that observed in other countries.

Epidemiology of cutaneous melanoma and non-melanoma skin cancer in Schleswig-Holstein, Germany: incidence, clinical subtypes, tumour stages and localization (epidemiology of skin cancer)

BACKGROUND

Population-based figures on skin cancer are essential for a realistic assessment of the personal disease burden, prevention modes and the need for caring. The Robert Koch Institute in Germany estimates the incidence of melanoma skin cancer as seven cases in 100 000 persons (age-standardized by the European standard rate). Population-based studies presumably show higher incidence rates of 10-16 cases in 100 000 persons. Few data exist for non-melanoma skin cancer (NMSC) as this is not systematically registered in Germany.

OBJECTIVES

To present the first population-based results from the Schleswig-Holstein (Germany) Cancer Registry on incidence, stage distribution, clinical types and localization of skin cancer and to compare the results with other studies.

METHODS

The Cancer Registry of the Bundesland Schleswig-Holstein with 3500 registering institutions, 100 of which are dermatological institutions, investigates all notifiable incident cancer cases according to international standards. From the recorded data all melanoma and NMSC cases were identified and evaluated.

RESULTS

Between 1998 and 2001, 1784 malignant melanoma (MM) and 12 956 NMSC cases underwent diagnostic and analytical evaluation. For MM, age-standardized incidence rates were 12.3 and 14.8 in 100 000 men and women, respectively, and the mean age of men was greater than that of women (56.6 vs. 54.9 years, P < 0.05). Superficial spreading melanoma was the most frequent clinical type (39.1%). The tumours were predominantly located on the trunk in men (46.8%) in contrast to leg and hip in women (39.5%). For NMSC, the age-standardized incidence rates were 100.2 and 72.6 in 100 000 men and women, respectively. More than 80% of all tumours were basal cell carcinoma.

CONCLUSIONS

The first population-based data from Schleswig-Holstein on the characteristics (age, sex, histological subtypes, localization and stage) of skin tumours agree well with the existing literature and may thus be regarded as representative. However, markedly higher incidences for MM and NMSC in the north of Germany compared with other parts of the country were observed. As the incidence rates from the north of Germany fit well into the European geographical pattern, we assume no regional increase. Therefore, the official German estimates on cutaneous tumours may largely depend on regional factors and may not be regarded as representative for all regions in Germany.