Socioeconomic status and cutaneous malignant melanoma in Northern Europe

• Published in: British journal of dermatology (1951) Vol. 170; no. 4; pp. 787 - 793
• Main Authors: Idorn, L.W., Wulf, H.C.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.04.2014; Wiley-Blackwell
• Subjects: Biological and medical sciences; Dermatology; Epidemiology; Europe - epidemiology; Female; General aspects; Health Knowledge, Attitudes, Practice; Holidays - statistics & numerical data; Humans; Incidence; Male; Medical sciences; Melanoma - epidemiology; Melanoma - mortality; Melanoma, Cutaneous Malignant; Miscellaneous; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Skin Neoplasms - epidemiology; Skin Neoplasms - mortality; Socioeconomic Factors; Sunbathing - statistics & numerical data; Sunburn - epidemiology; Sunlight - adverse effects; Tumors of the skin and soft tissue. Premalignant lesions; Ultraviolet Rays - adverse effects; Europe; Socioeconomic status; Dermatology; Malignant melanoma; North; Skin; Malignant tumor; Epidemiology; Social aspect; Public health; Cancer
• ISSN: 0007-0963; 1365-2133; 1365-2133
• DOI: 10.1111/bjd.12800

Summary Socioeconomic status (SES) is associated with cutaneous malignant melanoma (CMM) in Northern Europe, despite equal access to health care. SES per se is not responsible for this association, which must be ascribed to important risk factors for CMM such as intermittent ultraviolet radiation (UVR) exposure, and screening for CMM possibly owing to a greater knowledge and understanding of CMM. Our review of the literature showed that high SES is associated with increased risk of CMM, thinner tumours, increased survival and decreased mortality from CMM – the latter shown among women, and in recent studies also among men. There is evidence that high SES is associated with sun holidays, whereas low SES is associated with the use of sunbeds. Findings suggest that high SES is associated with the use of physicians and dermatologists for marks and moles, possibly owing to more knowledge and better understanding of CMM. We conclude that there has been a true increase in CMM incidence among high SES individuals in Northern Europe probably due to past intense intermittent UVR exposure, especially in connection with sun holidays. However, the increased risk of CMM and a better outcome of CMM in high SES individuals may also be conditioned by frequent recourse to physicians, which may be ascribed to more knowledge and better understanding of CMM, although more studies on this subject are warranted. Thicker CMM tumours and increased CMM mortality among low SES individuals in recent decades may reflect exposure to intermittent UVR, such as the use of sunbeds, as well as delayed diagnosis. What's already known about this topic? Socioeconomic status (SES) is associated with cutaneous malignant melanoma (CMM) in Northern Europe despite equal access to health care. It is not SES per se but risk factors for CMM that are responsible for this association. What does this study add? Intermittent ultraviolet radiation exposure from sun holidays, and possibly more knowledge and better understanding of CMM may be responsible for the increased incidence registered and decreased mortality from CMM among high SES individuals.