TOPICAL REVIEWGlobal perspectives of contemporary epidemiological trendsof cutaneous malignant melanomaM.B.LENS AND M.DAWES*John Radcliffe Hospital, University of Oxford, Oxford, U.K., and*Department of Family Medicine, McGill University, Montreal, CanadaAccepted for publication 20 July 2003Summary During the past several decades, there has been a substantial increase in the incidence of cutaneousmelanoma among all caucasian populations. The number of deaths due to cutaneous malignantmelanoma has also increased in most fair-skinned populations throughout the world in the past fewdecades. Trends in melanoma incidence worldwide are examined. The most recent data on themortality from cutaneous melanoma are reported. The role of different environmental, genetic andhost factors in the aetiology of melanoma is discussed.Key words: aetiology, incidence, melanoma, mortalityThe incidence of cutaneous malignant melanoma(CMM) has substantially increased among all cauca-sian populations in the last few decades.1Due to theincrease in incidence and the consequent mortality,CMM represents a significant and growing publichealth burden.Incidence of cutaneous malignant melanomaThe number of melanoma cases worldwide is increasingfaster than any other cancer. The annual increase inincidence rate varies between populations, but ingeneral has been in the order of 3–7% per year forfair-skinned Caucasian populations.1The estimatessuggested a doubling of melanoma incidence every10–20 years.2Table 1 shows incidence rates of CMMfor 23 selected countries reported in GLOBOCAN 2000.3In Australia, CMM is the fourth most commoncancer among males (after prostate cancer, bowelcancer and lung cancer) and the third most commoncancer among females (after breast cancer and bowelcancer).4Until recently, Queensland, Australia, hashad the highest melanoma incidence rate in cauca-sians. In the period between 1980 and 1987 thereported annual incidence of invasive melanoma inQueensland was 55Æ8 per 100 000 inhabitants for menand 42Æ9 per 100 000 inhabitants for women.5Theincidence of melanoma in men almost doubled duringthis period, reaching epidemic proportions, particularlyin individuals over age 50 years. Similar incidencerates were documented in New South Wales, Australia,where between 1986 and 1988 the annual incidenceof invasive melanoma was 52Æ5 per 100 000 in menand 42Æ9 per 100 000 in women.6Melanoma incidence data for Australia for 1983–1999 are presented in Figure 1. Recently reportedstatistical data suggest that the lifetime risk for devel-opment of melanoma in Australia is now 1 in 25 formen and 1 in 34 for women.7The incidence ofmelanoma has been decreasing in young women sincethe mid 1980s, but has continued to rise in older agegroups.8Analysis of the data from New Zealand suggestedthat in 1999 the caucasian population in the region ofAuckland, New Zealand, has the highest documentedincidence of melanoma in the world, with the crudeannual incidence for invasive CMM of 77Æ 7 per100 000 and the age-standardized annual rate of56Æ2 per 100 000, with no statistically significantdifferences in the rates for males and females. Thecumulative risk of developing melanoma over a lifetimein New Zealand has been reported to be 5Æ 7% overall(5Æ9% for males and 5Æ4% for females).9Correspondence: Dr Marko B. Lens.E-mail: [email protected] Journal of Dermatology 2004; 150: 179–185. 2004 British Association of Dermatologists 179The data from the U.S. Surveillance, Epidemiology,and End Results (SEER) registry (covering approxi-mately 14% of the U.S. population) showed thatmalignant melanoma was the most rapidly increasingmalignancy in both sexes in the U.S.A. during 1973–1997. In that period the age-adjusted melanomaincidence rates (expressed as the number of cases per100 000 person-years of observation) almost tripledamong males, from 6Æ7 in 1973 to 19Æ3 in 1997, andmore than doubled among females, from 5Æ9to13Æ8.10The age-adjusted incidence (per 100 000 population) ofall melanomas among SEER Registries in the U.S.A. inthe period from 1973 to 2000 is presented in Figure 2.The SEER age-adjusted incidence rate for melanomadiagnosed in the period from 1996 to 2000 was 21Æ8among males and 14Æ5 among females.11The incidenceof malignant melanoma has increased steadily in theU.S.A.: in 1935 the lifetime risk of an Americandeveloping melanoma was 1 in 1500 individuals, whilein 2002 the risk was 1 in 68 individuals.12Figure 3shows the lifetime risk of developing melanoma in theU.S.A. A statistical calculation estimated that in 2003CMM will be the fifth most common cancer amongmales and the seventh most common cancer amongfemales in the U.S.A.13In 2003, it is estimated that54 200 Americans will be diagnosed as having melan-oma, and 7600 will die of the disease.Trends in melanoma incidence by anatomical sitewere examined in Canada, where ascertainment ofcancer has been of a high standard. The analysis of41 239 patients with malignant melanomas registeredin Canada between 1969 and 1993 showed that theestimated annual increase in incidence was 4Æ8% formales and 3Æ1% for females.14The largest relativeincreases occurred for the upper limbs (5Æ7% annualchange for males and 4Æ3% for females), followed by thetrunk (5Æ6% annual change for males and 3Æ6% forfemales).In Europe the highest incidence rates have beenreported in Scandinavia (about 15 cases per 100 000Table 1. Incidence of cutaneous malignant melanoma (per100 000) for 23 selected countries3CountryMale FemaleCrude ASR Crude ASRAustralia 51Æ640Æ540Æ731Æ8New Zealand 45Æ236Æ744Æ434Æ9Sweden 19Æ812Æ619Æ913Æ3U.S.A. 16Æ413Æ312Æ99Æ4Denmark 14Æ810Æ617Æ613Æ0Switzerland 12Æ59Æ315Æ011Æ1The Netherlands 12Æ29Æ416Æ712Æ9Austria 11Æ58Æ815Æ410Æ4Canada 10Æ68Æ210Æ68Æ0Hungary 10Æ37Æ610Æ36Æ8Israel 9Æ79Æ411Æ09Æ8Germany 9Æ36Æ511Æ47Æ1France 8Æ66Æ811Æ17Æ9U.K. 8Æ36Æ111Æ37Æ7Poland 6Æ65Æ68Æ66Æ7Italy 6Æ54Æ68Æ25Æ5Russian Federation 6Æ35Æ46Æ44Æ7Spain 4Æ02Æ86Æ84Æ5South Africa 3Æ86Æ43Æ64Æ8Brazil 2Æ93Æ52Æ02Æ2Greece 2Æ51Æ93Æ22Æ0Japan 0Æ63 0Æ40 0Æ49 0Æ29China 0Æ21 0Æ22 0Æ17 0Æ17ASR, Age-standardized incidence rate.253035404550551983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999MalesFemalesFigure 1. Age-adjusted melanoma incidence (per 100 000) inAustralia, 1983–1999 (data from the National Cancer StatisticsClearing House at the Australian Institute of