Changing epidemiology of malignant cutaneous melanoma in Europe 1953–1997: Rising trends in incidence and mortality but recent stabilizations in Western Europe and decreases in Scandinavia

We analyzed time trends in incidence of and mortality from malignant cutaneous melanoma in European populations since 1953. Data were extracted from the EUROCIM database of incidence data from 165 cancer registries. Mortality data were derived from the WHO database. During the 1990s, incidence rates were by far highest in northern and western Europe, whereas mortality was higher in males in eastern and southern Europe. Melanoma rates have been rising steadily, albeit with substantial geographic variation. In northern Europe, a deceleration in these trends occurred recently in persons aged under 70. Joinpoint analyses indicated that changes in these trends took place in the early 1980s. In western Europe, mortality rates have also recently leveled off [estimated annual percentage change (EAPC) from −13.6% (n.s.) to 3.3%], whereas in eastern and southern Europe both incidence and mortality rates are still increasing [incidence EAPCs 2.3–8.9%, mortality EAPCs −1.8% (n.s.) to 7.2%]. Models including the effects of age, period and birth cohort were required to adequately describe the rising incidence trends in most European populations, with a few exceptions. Time trends in mortality were adequately summarized on fitting either an age‐cohort model (with the leveling off of rates starting in birth cohorts between 1930 and 1940) or an age‐period‐cohort model. The most plausible explanations for the deceleration or decline in the incidence and mortality trends in recent years in northern (and to a lesser extent western) Europe are earlier detection and more frequent excision of pigmented lesions and a growing public awareness of the dangers of excessive sunbathing. © 2003 Wiley‐Liss, Inc.

[1]  C. Garbe,et al.  Primary cutaneous melanoma. Prognostic classification of anatomic location , 1995, Cancer.

[2]  T. Mack,et al.  The pathogenesis of melanoma induced by ultraviolet radiation. , 1999, The New England journal of medicine.

[3]  J. Redburn,et al.  Improving survival of melanoma patients in Europe since 1978. EUROCARE Working Group. , 1998, European journal of cancer.

[4]  L. Dennis,et al.  Analysis of the melanoma epidemic, both apparent and real: data from the 1973 through 1994 surveillance, epidemiology, and end results program registry. , 1999, Archives of dermatology.

[5]  H. Frydman,et al.  Malignant melanoma. Changing trends in factors influencing metastasis‐free survival from 1964 to 1982 , 1990, Cancer.

[6]  B. Armstrong,et al.  A theory of the etiology and pathogenesis of human cutaneous malignant melanoma. , 1983, Journal of the National Cancer Institute.

[7]  D. English,et al.  Descriptive epidemiology of skin cancer , 2004 .

[8]  A. Jemal,et al.  Cancer surveillance series: changing patterns of cutaneous malignant melanoma mortality rates among whites in the United States. , 2000, Journal of the National Cancer Institute.

[9]  B. Armstrong,et al.  Health, Solar UV Radiation and Environmental Change , 1993 .

[10]  N Cascinelli,et al.  Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  TR Hawkins Re-reading Silent Spring. , 1994, Environmental health perspectives.

[12]  Geller,et al.  Melanoma and Skin Cancer Control: An International Perspective. , 1995, Cancer control : journal of the Moffitt Cancer Center.

[13]  J. Nectoux,et al.  Temporal change in diagnostic criteria as a cause of the increase of malignant melanoma over time is unlikely , 1991, International journal of cancer.

[14]  P. Boyle,et al.  Mortality from cutaneous melanoma: evidence for contrasting trends between populations , 2000, British Journal of Cancer.

[15]  J. Bulliard,et al.  Cutaneous malignant melanoma in New Zealand: trends by anatomical site, 1969-1993. , 2000, International journal of epidemiology.

[16]  U. Ringborg,et al.  Trends in Incidence of Cutaneous Malignant Melanoma in a Swedish Population 1976-1994 , 2002, Acta oncologica.

[17]  G. Bentham,et al.  Gender, geography and socio-economic status in the diffusion of malignant melanoma risk. , 1996, Social science & medicine.

[18]  D Clayton,et al.  Models for temporal variation in cancer rates. I: Age-period and age-cohort models. , 1987, Statistics in medicine.

[19]  J. Bulliard Site‐specific risk of cutaneous malignant melanoma and pattern of Sun exposure in New Zealand , 2000, International journal of cancer.

[20]  J. Coebergh,et al.  Invasive cutaneous melanoma in The Netherlands, 1989-1990. , 1996, European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation.

[21]  J. Coebergh,et al.  Site, histological type, and thickness of primary cutaneous malignant melanoma in western Netherlands since 1980 , 1997, The British journal of dermatology.

[22]  B K Armstrong,et al.  Melanoma of the skin. , 1984, British medical bulletin.

[23]  C. la Vecchia,et al.  Recent declines in worldwide mortality from cutaneous melanoma in youth and middle age , 1999, International journal of cancer.

[24]  A. Marghoob,et al.  Ultraviolet A and melanoma: a review. , 2001, Journal of the American Academy of Dermatology.

[25]  J. Bulliard,et al.  Prevention of cutaneous melanoma: an epidemiological evaluation of the Swiss campaign. , 1992, Revue d'epidemiologie et de sante publique.

[26]  J. J. Grob,et al.  Epidemiology, causes, and prevention of skin diseases , 1997 .

[27]  K. Jöckel,et al.  Skin melanoma in Saarland: incidence, survival and mortality 1970–1996 , 2001, European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation.

[28]  B. Armstrong,et al.  How much melanoma is caused by sun exposure? , 1993, Melanoma research.

[29]  P. Sparén,et al.  Clinical and histopathologic predictors of survival in patients with malignant melanoma: a population-based study in Sweden. , 1994, Journal of the National Cancer Institute.

[30]  K. Vossaert,et al.  Current Guidelines in Melanoma Treatment , 2000, Dermatology.

[31]  J. Mark Elwood,et al.  Melanoma and sun exposure: An overview of published studies , 1997, International journal of cancer.

[32]  G. Bentham,et al.  Incidence of malignant melanoma of the skin in Norway, 1955-1989: associations with solar ultraviolet radiation, income and holidays abroad. , 1996, International journal of epidemiology.

[33]  S. Moss,et al.  Evaluation of primary prevention initiatives for skin cancer: a review from a U.K. perspective , 2000, The British journal of dermatology.

[34]  Coebergh,et al.  Increase in and stabilization of incidence and mortality of primary cutaneous malignant melanoma in western Netherlands, 1980–95 , 1999, The British journal of dermatology.

[35]  E. Feuer,et al.  Permutation tests for joinpoint regression with applications to cancer rates. , 2000, Statistics in medicine.

[36]  M. Nicolson,et al.  Incidence of and survival from malignant melanoma in Scotland: an epidemiological study , 2002, The Lancet.

[37]  P. Gies,et al.  Solar and ultraviolet radiation , 2004 .

[38]  Jacques Estève,et al.  Trends in cancer incidence and mortality. , 2009 .

[39]  H. Williams,et al.  Evaluation of public education campaigns in cutaneous melanoma: the King's College Hospital experience , 1990, The British journal of dermatology.

[40]  D. Whiteman,et al.  Childhood sun exposure as a risk factor for melanoma: a systematic review of epidemiologic studies , 2004, Cancer Causes & Control.

[41]  Hyune-Ju Kim,et al.  Kim H-J, Fay MP, Feuer EJ, Midthune DN, ‘ Permutation tests for joinpoint regression with applications to cancer rates’. Statistics in Medicine 2000 19:335–351 , 2001 .

[42]  D. Wagener Patterns of Melanoma Deaths in the United States , 1990, Annals of the New York Academy of Sciences.

[43]  A. Streetly,et al.  Changing trends in the epidemiology of malignant melanoma: gender differences and their implications for public health. , 1995, International journal of epidemiology.

[44]  B. Kulle,et al.  Survival probabilities and hazard functions of malignant melanoma in Germany 1972-1996, an analysis of 10433 patients. Evolution of gender differences and malignancy. , 2002, European journal of cancer.

[45]  Bjørn Møller,et al.  Prediction of cancer incidence in the Nordic countries up to the year 2020. , 2002, European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation.

[46]  D Clayton,et al.  Models for temporal variation in cancer rates. II: Age-period-cohort models. , 1987, Statistics in medicine.

[47]  L. Dennis,et al.  Recent cohort trends in malignant melanoma by anatomic site in the United States , 1993, Cancer Causes & Control.