Cutaneous malignant melanoma in Scotland: incidence, survival, and mortality, 1979-94

• Published in: BMJ Vol. 315; no. 7116; pp. 1117 - 1121
• Main Authors: MacKie, Rona M, Hole, David, Hunter, John A A, Rankin, Rosslyn, Evans, Alan, McLaren, Kathryn, Fallowfield, Mary, Hutcheon, Andrew, Morris, Arthur
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 01.11.1997; British Medical Association; BMJ Publishing Group LTD; BMJ Publishing Group
• Edition: International edition
• Subjects: Age groups; Biological and medical sciences; Dermatology; Hospital buildings; Lesions; Medical research; Medical sciences; Medical specialists; Melanoma; Men; Mortality; Neoplasia; Pathology; Skin cancer; Survival rates; Tropical medicine; Tumors of the skin and soft tissue. Premalignant lesions; Women; United Kingdom; Scotland; Great Britain; Europe; United Kingdom > UK; Human; Evaluation; Skin disease; Mortality; Malignant tumor; Epidemiology; Survival; Incidence; Public health organization; Trend analysis; Risk factor; Malignant melanoma; Female; Skin; Diagnosis; Public health
• ISSN: 0959-8138; 0959-8146; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.315.7116.1117

Abstract Objective: To determine the changing incidence of and mortality from cutaneous malignant melanoma in Scotland from 1979 to 1994. Design: Detailed registration of clinical and pathological features, surgical and other treatment, and follow up of all cases of cutaneous malignant melanoma diagnosed from 1979 to 1994 and registered with specialist database for Scotland. Setting: Scotland. Subjects: 6288 patients with invasive primary cutaneous malignant melanoma diagnosed between 1 January 1979 and 31 December 1994. Results: The annual age standardised incidence of cutaneous malignant melanoma rose significantly from 3.5 to 7.8 per 100 000 per year in men and from 6.8 to 12.3 per 100 000 per year in women (P<0.001 for both). World standardised rates increased from 2.7 to 6.0 per 100 000 per year in men and 4.6 to 8.50 per 100 000 in women. The incidence of melanoma continued to increase significantly in men of all ages during the study, but the rate stabilised in women after 1986. Mortality from cutaneous malignant melanoma was 1.3 per million per annum in men in 1979, rising to 2.3 per million per annum in 1994 (P<0.01); it was 2.4 per million per annum in women in 1979, falling to 1.9 per million per annum in 1994 (P=0.09). The underlying mortality trends showed a continuing rise for men but a downward trend for women that was not significant (P=0.09). In men, melanoma free survival was 69% at 5 years and 61% at 10 years; in women the corresponding rates were 82% and 75%. Younger patients had higher survival rates, which were not entirely explained by thinner tumours. Over the 15 year period, survival rates improved by 12% overall, only partly owing to thinner tumours. Conclusions: In Scotland the incidence of melanoma in women has stabilised, while mortality associated with melanoma in women shows a downward trend. Key messages Data from Scotland based on 6288 patients with primary invasive cutaneous malignant melanoma show a rise overall in the incidence of melanoma over 15 years but a stabilisation in the incidence of melanoma in women under 65 since 1986 Mortality associated with melanoma is now falling in women of all ages, especially in women under 65 Survival prospects remain strongly related to tumour thickness at the time of diagnosis: disease free survival at 5 years for patients with melanoma thinner than 1.5 mm was 96% in women and 91% in men, while for those with tumours thicker than 3.5 mm survival was 54% and 42% respectively