New melanoma therapies are being developed rapidly, complementing prevention and detection strategies for disease control. Estimating the future burden of melanoma is necessary for deciding how best ...to deploy limited resources to achieve effective melanoma control. Using three decades of cancer registry data (1982–2011) from six populations with moderate to high melanoma incidence (US whites and the populations of the United Kingdom, Sweden, Norway, Australia, New Zealand), we applied age-period-cohort models to describe current trends and project future incidence rates and numbers of melanomas out to 2031. Between 1982 and 2011, melanoma rates in US whites, and the populations of the United Kingdom, Sweden, and Norway increased at more than 3% annually and are projected to continue rising until at least 2022. Melanoma incidence in Australia has been declining since 2005 (–0.7% per year), and melanoma incidence in New Zealand is increasing but is projected to decline soon. The numbers of new melanoma cases will rise in all six populations because of aging populations and high age-specific rates in the elderly. In US whites, annual new cases will rise from around 70,000 in 2007–2011 to 116,000 in 2026–2031, with 79% of the increase attributable to rising age-specific rates and 21% to population growth and aging. The continued increases in case numbers in all six populations through 2031 will increase the challenges of melanoma control.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
While ultraviolet (UV) radiation exposure is a recognized risk factor for skin cancer, associations are complex and few studies have allowed a direct comparison of exposure profiles associated with ...cutaneous melanoma, basal-cell carcinoma (BCC), and squamous-cell carcinoma (SCC) within a single population.
We examined associations between UV exposures and skin cancer risk in a nested case-control study within E3N, a prospective cohort of 98,995 French women born in 1925-1950. In 2008, a lifetime UV exposure questionnaire was sent to all reported skin cancer cases and three controls per case, which were matched on age, county of birth, and education. Analyses were performed using conditional logistic regression and included 366 melanoma cases, 1,027 BCC cases, 165 SCC cases, and 3,647 controls.
A history of severe sunburns <25 years was associated with increased risks of all skin cancers (melanoma: OR 2.7; BCC: OR 1.7; SCC: OR 2.0 for ≥6 sunburns vs. none), while sunburns ≥25 years were associated with BCC and SCC only. While high-sun protection factor sunscreen use before age 25 was associated with lower BCC risk (P
= 0.02), use since age 25 and reapplication of sunscreen were associated with higher risks of all three types of skin cancer. There were positive linear associations between total UV score and risks of BCC (P
= 0.01) and SCC (P
= 0.09), but not melanoma. While recreational UV score was strongly associated with BCC, total and residential UV scores were more strongly associated with SCC.
Melanoma, BCC, and SCC are associated with different sun exposure profiles in women.
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FFLJ, NUK, ODKLJ, UL, UM, UPUK
Objectives: To assess the incidence and multiplicity of keratinocyte cancers (basal cell carcinoma BCC and squamous cell carcinoma SCC) excised in Australia, and to examine variations by age, sex, ...state, and prior skin cancer history.
Design: Analysis of individual‐level Medicare data for keratinocyte cancer treatments (identified by eight specific MBS item codes) during 2011–2014. Histological data from the QSkin prospective cohort study were analysed to estimate BCC and SCC incidence.
Setting: A 10% systematic random sample of all people registered with Medicare during 1997–2014.
Participants: People aged at least 20 years in 2011 who made at least one claim for any MBS medical service during 2011–2014 (1 704 193 individuals).
Main outcome measures: Age‐standardised incidence rates (ASRs) and standardised incidence ratios (SIRs).
Results: The person‐based incidence of keratinocyte cancer excisions in Australia was 1531 per 100 000 person‐years; incidence increased with age, and was higher for men than women (SIR, 1.43; 95% CI, 1.42–1.45). Lesion‐based incidence was 3154 per 100 000 person‐years. The estimated ASRs for BCC and SCC were 770 per 100 000 and 270 per 100 000 person‐years respectively. During 2011–2014, 3.9% of Australians had one keratinocyte cancer excised, 2.7% had more than one excised; 74% of skin cancers were excised from patients who had two or more lesions removed. Multiplicity was strongly correlated with age; most male patients over 70 were treated for multiple lesions. Keratinocyte cancer incidence was eight times as high among people with a prior history of excisions as among those without.
Conclusions: The incidence and multiplicity of keratinocyte cancer in Australia are very high, causing a large disease burden that has not previously been quantified.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
IMPORTANCE: Men and women develop melanoma at different rates on different body sites, with variation across countries, but explanations for these disparities remain elusive. OBJECTIVE: To test ...whether observed differences in melanoma incidence between men and women vary by population, age, or anatomic site. DESIGN: Cross-sectional analysis of sex- and site-specific temporal trends in melanoma incidence over 3 decades was conducted for men and women diagnosed with invasive melanoma in the US (limited to white race), Canada, Australia, New Zealand, the UK, Sweden, Norway, and Denmark. Using cancer registry data, male to female incidence rate ratios (IRRs) were calculated overall and by anatomic site, and Joinpoint regression models were used to estimate the annual percentage rate changes in sex- and site-specific incidence in each population. Incidence rates were standardized to the US 2000 population. Data on the incidence between January 1, 1982, and December 31, 2015, were obtained; analysis was conducted from March 1 to October 15, 2019. MAIN OUTCOMES AND MEASURES: Male to female IRRs and annual percentage change in rates. RESULTS: Total melanoma incidence was higher in men than women in US individuals (limited to white race), Canada, Australia, and New Zealand, but not in Denmark, the UK, Norway, and Sweden. In all populations, men had higher rates of melanoma of the head and neck and trunk than women (male to female IRR >1), but lower melanoma rates on the lower limbs (ie, male to female IRR approximately 0.5). The male to female IRR increased log linearly with age, with excess melanomas in women younger than 45 years in all populations (eg, IRR for 20-24 y age group, 0.3 in Denmark and 0.7 in Australia), and excess melanomas in men older than 69 years (eg, IRR for 70-74 y age group, 1.1 in Denmark and 2.1 in the US white population). The age at which the melanoma incidence in men exceeded the melanoma incidence in women differed by population, being achieved the earliest in Australia (45-49 years) and latest in Denmark (65-69 years). CONCLUSIONS AND RELEVANCE: In predominantly fair-skinned populations, melanoma incidence appears to differ systematically and consistently between men and women by age and anatomic site.
Relatively little is known about the epidemiology of Merkel cell carcinoma (MCC) with regard to international trends in incidence, specifically relating to differences by age, sex, and anatomic site. ...We examined the trends in sex-specific incidence of MCC in the United States, Australia, New Zealand, Scotland, and Norway over a 20-year period (1997–2016) as well as the site-specific incidence trends in the United States. We used Joinpoint regression models to estimate the average annual percentage change in the incidence. In the total United States population, we observed an average annual percentage change of 2.7% (95% confidence interval CI = 2.0–3.3) for MCC, with sex-specific incidence increasing from 0.55 to 1.03 per 100,000 in men and from 0.28 to 0.45 per 100,000 in women. MCC incidence also increased in Queensland, Australia (average annual percentage change 1.8%, 95% CI = 0.7–2.8), New Zealand (2.0%, 95% CI = 0.4–3.7), Scotland (3.7%, 95% CI = 2.0–5.5), and Norway (4.0%, 95% CI = 2.1–5.9). In all populations, MCC incidence was higher in men than in women. Between 1993 and 2016 in the United States, the incidence of MCC of the head and neck and upper and lower limbs increased in both sexes. Despite being an uncommon malignancy, our analyses show that MCC incidence is steadily increasing both in areas of low and those of high ambient UVR levels.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Melanoma incidence has been rising in populations with predominantly European ancestry (White), speculated to be partly driven by heightened detection of indolent tumors. If in situ melanomas are ...destined to evolve to invasive cancers, detecting and removing them should deplete the pool of invasive lesions, and people with in situ melanoma should, on average, be younger than those with invasive melanoma.
We analyzed long-term incidence trends (1982-2018) for in situ and invasive melanomas in 3 predominantly White populations with high, medium, and low melanoma rates: Queensland (Australia), United States White, and Scotland. We calculated the incidence rate ratio (IRR) of in situ to invasive melanomas and estimated the contributions of age, period, and cohort effects. We compared age at diagnosis of in situ vs invasive melanomas overall and stratified by sex and anatomic site.
In all 3 populations, the in situ to invasive incidence rate ratio increased statistically significantly from less than 0.3 in 1982 to 1.95 (95% confidence interval CI = 1.88 to 2.02) in Queensland, 0.93 (95% CI = 0.90 to 0.96) in the US White population, and 0.58 (95% CI = 0.54 to 0.63) in Scotland in 2018. The mean age at diagnosis of in situ melanomas was the same or higher than invasive melanomas for almost all time periods among men and women and on all body sites except the lower limbs.
The increasing ratio of in situ to invasive melanoma incidence over time, together with the high (and increasing) mean age at diagnosis of in situ melanomas, is consistent with more indolent lesions coming to clinical attention than in previous eras.
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