Department of Dermatology, Stanford University School of Medicine, Stanford, California.
Program for Clinical Research and Technology, Department of Dermatology, Stanford University School of Medicine, Stanford, California.
JAMA Oncol. 2022 May 1;8(5):755-759. doi: 10.1001/jamaoncol.2022.0134.
The recent incidence of cutaneous melanoma of different thicknesses in the US is not well described.
To evaluate recent patterns in the incidence of melanoma by tumor thickness and examine associations of sex, race and ethnicity, and socioeconomic status with melanoma thickness-specific incidence.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study analyzed data for 187 487 patients with a new diagnosis of invasive cutaneous melanoma from the Surveillance, Epidemiology, and End Results Registry from January 1, 2010, to December 31, 2018. The study was conducted from May 27 to December 29, 2021. Data were analyzed from June 21 to October 24, 2021.
Age-adjusted incidence rates of melanoma were calculated by tumor thickness (categorized by Breslow thickness) and annual percentage change (APC) in incidence rates. Analyses were stratified by sex and race and ethnicity. The associations with socioeconomic status were evaluated in 134 359 patients diagnosed with melanoma from 2010 to 2016.
This study included 187 487 patients with a median (IQR) age of 62 (52-72) years and 58.4% men. Melanoma incidence was higher in men compared with women across all tumor thickness groups. Individuals in lower socioeconomic status quintiles and members of minority groups were more likely to be diagnosed with thicker (T4) tumors (20.7% [169 of 816] among non-Hispanic Black patients, 11.2% [674 of 6042] among Hispanic patients, and 6.3% [10 774 of 170 155] among non-Hispanic White patients). Between 2010 and 2018, there was no significant increase in incidence of cutaneous melanoma across the full population (APC, 0.39%; 95% CI, -0.40% to 1.18%). The incidence of the thickest melanomas (T4, >4.0 mm) increased between 2010 and 2018, with an APC of 3.32% (95% CI, 2.06%-4.60%) overall, 2.50% (95% CI, 1.27%-3.73%) in men, and 4.64% (95% CI, 2.56%-6.75%) in women.
In this population-based cohort study, the incidence of the thickest cutaneous melanoma tumors increased from 2010 to 2018, in contrast with the incidence patterns for thinner melanomas. The findings suggest potential stabilization of overall melanoma incidence rates in the US after nearly a century of continuous increase in incidence. Patients with low socioeconomic status and Hispanic patients were more likely to be diagnosed with thick melanoma. The continued rise in incidence of thick melanoma is unlikely to be attributable to overdiagnosis given the stability of thin melanoma rates.
美国不同厚度皮肤黑色素瘤的近期发病率尚不清楚。
评估黑色素瘤肿瘤厚度的近期发病模式，并研究性别、种族和民族以及社会经济地位与黑色素瘤厚度特定发病率的关系。
设计、地点和参与者：本基于人群的队列研究分析了 2010 年 1 月 1 日至 2018 年 12 月 31 日期间来自监测、流行病学和最终结果登记处的 187487 例新诊断的侵袭性皮肤黑色素瘤患者的数据。研究于 2021 年 5 月 27 日至 12 月 29 日进行。数据分析于 2021 年 6 月 21 日至 10 月 24 日进行。
按肿瘤厚度（按 Breslow 厚度分类）和发病率的年百分比变化（APC）计算黑色素瘤的年龄调整发病率。按性别和种族和民族进行分层分析。在 2010 年至 2016 年间诊断出黑色素瘤的 134359 例患者中评估了与社会经济地位的关联。
这项研究包括 187487 例患者，中位（IQR）年龄为 62（52-72）岁，其中 58.4%为男性。与所有肿瘤厚度组相比，男性黑色素瘤发病率均高于女性。社会经济地位较低五分位的个体和少数群体成员更有可能被诊断为较厚（T4）肿瘤（20.7%[816 例中的 169 例]非西班牙裔黑人患者，11.2%[6042 例中的 674 例]西班牙裔患者和 6.3%[170155 例中的 10774 例]非西班牙裔白人患者）。2010 年至 2018 年间，整个人群的皮肤黑色素瘤发病率没有显著增加（APC，0.39%；95%CI，-0.40%至 1.18%）。最厚的黑色素瘤（T4，>4.0mm）的发病率在 2010 年至 2018 年间有所增加，总体 APC 为 3.32%（95%CI，2.06%-4.60%），男性为 2.50%（95%CI，1.27%-3.73%），女性为 4.64%（95%CI，2.56%-6.75%）。
在这项基于人群的队列研究中，最厚的皮肤黑色素瘤肿瘤的发病率从 2010 年增加到 2018 年，与较薄黑色素瘤的发病模式形成对比。研究结果表明，在美国，黑色素瘤发病率在近一个世纪持续上升后，总体发病率可能趋于稳定。社会经济地位较低的患者和西班牙裔患者更有可能被诊断为厚黑色素瘤。考虑到薄黑色素瘤发病率的稳定，厚黑色素瘤发病率的持续上升不太可能归因于过度诊断。
