Abstract
Background: Melanoma incidence rates have increased dramatically in white populations worldwide during the past several decades. A more modest increase has been observed for melanoma-related mortality. Cause-specific and disease-free survivals are related to tumor characteristics, gender, age, and possibly anatomic site. It is difficult to accurately assess these trends without information on tumor thickness that is often unavailable. Objective: This study determines trends in melanoma incidence, mortality, and survival in Saskatchewan for a 30-year period, incorporating analysis of tumor thickness. Methods: Information about cases of primary cutaneous melanoma for the 30-year period 1970–1999 was obtained from the population-based Saskatchewan Cancer Registry. A 50% random sample of charts was reviewed to collect information about Breslow depth, Clark level, and other demographic data not available from the Registry. Multivariate regression analysis was used to determine the significance of prognostic factors on incidence and five-year relative survival rates. Results: The number of patients registered increased dramatically during the study period. The increase was greatest for thin lesions in all age groups. Anatomic site varied by gender. Head and neck tumors showed continual increase in risk with increasing age. Mortality rates in females have been stable over time but increased for males in the 1990s. The prognostic factors that predicted excess mortality at five years were tumor thickness, Clark level, and gender. Conclusion: The observed increase in melanoma appears to be real and not the result of increased surveillance or screening. Tumor characteristics (Breslow depth, Clark level) and gender were significant prognostic indicators of five-year excess mortality.
Antécédents: Au cours des dernières décennies, le taux d’incidence des mélanomes au sein des populations blanches a augmenté de façon considérable. Une légère hausse a été observée dans le taux de mortalité liée à cette condition. Les survies par cause et sans récidive sont fonction des caractéristiques de la tumeur et possiblement de son site, ainsi que du sexe et de l’âge du patient. Il est difficile d’évaluer précisément ces tendances sans les données, souvent inexistantes, sur l’épaisseur de la tumeur. Objectif: L’étude détermine les tendances de l’incidence des mélanomes, de la mortalité et de la survie en Saskatchewan au cours d’une période de trente ans, et comporte une analyse de l’épaisseur des tumeurs. Méthodes: Des données sur des cas de mélanomes primitifs durant un intervalle de 30 ans (1970–1999) ont été obtenues du Saskatchewan Cancer Registry. Un échantillon randomisé de 50% des dossiers a été examiné en vue de tirer de l’information sur l’indice de Breslow, le niveau d’invasion de Clark et autres données démographiques qui ne figurent pas dans le registre. Une analyse multivariable de régression a été effectuée afin de déterminer l’importance des facteurs de pronostic sur l’incidence et les taux de survie de cinq ans. Résultats: Le nombre de patients inscrits a augmenté considérablement au cours de la durée de l’étude. Une hausse marquée des cas de lésions minces a été notée dans toutes les fourchettes d’âge. Les sites des tumeurs varient selon le sexe. Les risques que présentent les tumeurs à la tête et à la nuque augmentent avec l’âge. Le taux de mortalité chez les femmes s’est stabilisé avec le temps; le taux de mortalité chez les hommes a augmenté durant les années 1990. Les facteurs influant sur le pronostic de cinq ans sont l’épaisseur de la tumeur, le niveau d’invasion de Clark et le sexe du patient. Conclusion: L’augmentation observée des cas de mélanomes semble réelle et non le résultat d’un meilleur suivi ou d’un dépistage plus efficace. Les caractéristiques des tumeurs (indice de Breslow et niveau de Clark) et le sexe des patients sont des indicateurs d’un pronostic de surmortalité de cinq ans.
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Acknowledgements
The authors thank Diane Robson of the Saskatchewan Cancer Agency Registry for supplying the data for the study. Dr. Vincent Falck and Dr. Duane Barber provided expertise in review of pathology slides when required. Dr. Bruce Reeder and Dr. Paul Peloso provided important guidance as advisors throughout the study.
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Support for this work was provided by the College of Medicine, University of Saskatchewan Scholarship Fund. Presented at the Canadian Dermatology Association 76th Annual Meeting, Halifax, Nova Scotia, July 2001.
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Ulmer, M.J., Tonita, J.M. & Hull, P.R. Trends in Invasive Cutaneous Melanoma in Saskatchewan 1970–1999 . JCMS 7, 433–442 (2003). https://doi.org/10.1007/s10227-003-0159-0
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DOI: https://doi.org/10.1007/s10227-003-0159-0