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Original Investigation |

Incidence of In Situ and Invasive Melanoma in Denmark From 1985 Through 2012 A National Database Study of 24 059 Melanoma Cases

Neel Maria Helvind, MD1; Lisbet Rosenkrantz Hölmich, MD, DMSc2,3; Sigrun Smith, Bach San Scient Publ4; Martin Glud, MD, PhD5; Klaus Kaae Andersen, PhD4; Susanne Oksbjerg Dalton, MD, PhD4; Krzysztof Tadeusz Drzewiecki, MD, DMSc1,3
[+] Author Affiliations
1Department of Plastic Surgery, Breast Surgery, and Burns, University Hospital Rigshospitalet, Copenhagen, Denmark
2Department of Plastic Surgery, University Hospital Herlev, Herlev, Denmark
3Danish Melanoma Group (DMG), Department of Plastic Surgery, Herlev Hospital, Herlev, Denmark
4Danish Cancer Society Research Center, Copenhagen, Denmark
5Department of Dermatology, University Hospital Bispebjerg, Copenhagen, Denmark
JAMA Dermatol. 2015;151(10):1087-1095. doi:10.1001/jamadermatol.2015.1481.
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Importance  In Denmark, the incidence of malignant melanoma (MM) has doubled during the past 25 years, with an incidence of 29.5 and 31.7 per 100 000 person-years in 2012 for men and women, respectively. Understanding the nature of this increase in incidence is important to optimize prevention, early diagnosis, and treatment of in situ and invasive melanoma in Denmark.

Objective  To describe changes over time in the incidence and clinical and pathologic characteristics of in situ and invasive melanoma in Denmark from 1985 through 2012.

Design, Setting, and Participants  We used the official national Danish Melanoma Group database to describe all eligible, prospectively registered cases of in situ and invasive melanoma in Denmark from January 1, 1985, through December 31, 2012. Data analyses were performed from April 1, 2012, through January 31, 2013.

Main Outcomes and Measures  Estimated annual percentage changes (EAPCs) for men and women in European age-standardized incidence, age at diagnosis, and tumor region for in situ melanoma and MM. For MM only, melanoma type, Breslow thickness, ulceration, and mortality.

Results  We included 3299 cases of in situ melanoma and 20 760 cases of MM. The incidence (95% CI) of MM increased by 4.5% (3.6%-5.3%) for men and 4.3% (3.5%-5.2%) for women, which was especially pronounced in patients older than 60 years (EAPCs, 5.8% [4.7%-6.8%] and 4.8% [3.8%-5.9%], respectively), in thin (Breslow thickness, <0.75 mm) melanoma (EAPCs, 6.6% [5.0%-8.2%] and 6.1% [6.0%-7.1%], respectively), and in superficially spreading MM (EAPCs, 5.2% [4.3%-6.2%] and 4.7% [3.9%-5.7%], respectively). We found no significant EAPC in the incidence of melanomas with Breslow thickness greater than 2.00 mm in women, and relative ulceration rates (95% CI) declined in both sexes (EAPCs, −3.3% [−4.0% to −2.6%] in men and −3.4% [−4.0% to −2.8%] in women). More proximal tumor location occurred over time (P < .001). Incidence of in situ melanoma (95% CI) greatly increased (EAPCs, 14.0% [12.2%-15.8%] in men and 11.6% [10.2%-13.2%] in women) with changes over time in age and region (defined by codes in the International Statistical Classification of Diseases, Tenth Revision) similar to those for MM. Mortality related to MM increased in men (EAPC, 0.6% [0.1% to 1.2%]), whereas mortality in women (EAPC, −0.4% [−1.0% to 0.3%]) remained stable.

Conclusions and Relevance  This study confirms a worldwide increase in melanoma incidence. Results may indicate the importance of secondary melanoma prevention in Denmark. Future efforts could intensify primary prevention aimed at young adults, adolescents, and children and maintain and target secondary prevention at the population older than 60 years.

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Figure 1.
Incidence of Melanoma in Denmark, 1985 Through 2012

A, Incidence of malignant melanoma. DMG indicates Danish Melanoma Group; NORDCAN, Cancer Incidence, Mortality, Prevalence and Survival in the Nordic Countries database, Association of Nordic Cancer Registries. B, Incidence of in situ melanoma.

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Figure 2.
Mortality Owing to Malignant Melanoma in Denmark, 1985 Through 2012

Data represent European age-standardized mortality rates. National data are from the NORDCAN (Cancer Incidence, Mortality, Prevalence and Survival in the Nordic Countries database, Association of Nordic Cancer Registries).

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Figure 3.
Change Over Time in Distribution of In Situ Melanoma in Denmark, 1985 Through 2012

Incidence of in situ melanoma by age at diagnosis (A and B) and International Statistical Classification of Diseases, Tenth Revision (ICD-10) region (C and D).

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