Department of Plastic Surgery, Breast Surgery, and Burns, University Hospital Rigshospitalet, Copenhagen, Denmark.
Department of Plastic Surgery, University Hospital Herlev, Herlev, Denmark3Danish Melanoma Group (DMG), Department of Plastic Surgery, Herlev Hospital, Herlev, Denmark.
JAMA Dermatol. 2015 Oct;151(10):1087-95. doi: 10.1001/jamadermatol.2015.1481.
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.
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.
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.
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.
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.
在过去的 25 年中，丹麦的恶性黑色素瘤（MM）发病率增加了一倍，男性和女性的发病率分别为每 100,000 人年 29.5 和 31.7。了解发病率的这种增加的性质对于优化丹麦原位和侵袭性黑色素瘤的预防、早期诊断和治疗非常重要。
描述 1985 年至 2012 年期间丹麦原位和侵袭性黑色素瘤的发病率以及临床和病理特征随时间的变化。
设计、地点和参与者：我们使用官方的丹麦黑色素瘤组数据库描述了 1985 年 1 月 1 日至 2012 年 12 月 31 日期间丹麦所有符合条件的、前瞻性注册的原位和侵袭性黑色素瘤病例。数据分析于 2012 年 4 月 1 日至 2013 年 1 月 31 日进行。
用于描述男性和女性的欧洲年龄标准化发病率、诊断时年龄和原位黑色素瘤和 MM 肿瘤部位的估计年百分比变化（EAPC）。仅对于 MM，黑色素瘤类型、Breslow 厚度、溃疡和死亡率。
我们纳入了 3299 例原位黑色素瘤和 20,760 例 MM 病例。MM 的发病率（95%CI）男性增加了 4.5%（3.6%-5.3%），女性增加了 4.3%（3.5%-5.2%），尤其是 60 岁以上的患者更为明显（EAPC，分别为 5.8%[4.7%-6.8%]和 4.8%[3.8%-5.9%]），在薄（Breslow 厚度，<0.75 毫米）黑色素瘤（EAPC，分别为 6.6%[5.0%-8.2%]和 6.1%[6.0%-7.1%]），和在浅表扩散 MM（EAPC，分别为 5.2%[4.3%-6.2%]和 4.7%[3.9%-5.7%]）。我们没有发现女性 Breslow 厚度大于 2.00 毫米的黑色素瘤发病率的显著 EAPC，而且两性的相对溃疡率（95%CI）都在下降（男性为 -3.3%[-4.0%至-2.6%]，女性为-3.4%[-4.0%至-2.8%]）。近端肿瘤位置随时间发生变化（P<.001）。原位黑色素瘤的发病率（95%CI）大幅增加（男性为 14.0%[12.2%-15.8%]，女性为 11.6%[10.2%-13.2%]），年龄和区域（通过第十版国际疾病分类的代码定义）随时间发生变化，与 MM 相似。男性与 MM 相关的死亡率增加（EAPC，0.6%[0.1%至 1.2%]），而女性的死亡率（EAPC，-0.4%[-1.0%至 0.3%]）保持稳定。
本研究证实了黑色素瘤发病率的全球增加。结果可能表明丹麦二级黑色素瘤预防的重要性。未来的努力可以加强针对年轻人、青少年和儿童的一级预防，并维持和针对 60 岁以上人群的二级预防。
