Franceschi S, Bidoli E, Prati S, Fascioli S, La Vecchia C
Servizio di Epidemiologia, Centro di Riferimento Oncologico, Aviano (Pordenone), Italy.
Tumori. 1994 Aug 31;80(4):251-6. doi: 10.1177/030089169408000401.
Substantial upward trends for skin cancer mortality have been observed in most European countries in the last two decades. The distinction, however, between cutaneous malignant melanoma (CMM) and non-melanomatous skin cancers on the basis of death certification is unreliable.
In order to assess the trends of CMM, analysis of the specific code for CMM (International Classification of Disease VIII and IX:172) was coupled with analysis of total skin cancer mortality rates, standardized on the 1981 Italian Census population, at all ages and in selected age groups (15-44, 45-64 and 65-84 years). The analyses were carried out for the whole of Italy and for Friuli-Venezia Giulia (FVG), a region in North-East Italy with a high proportion of fair-complexioned individuals, elevated frequency of sunbathing, and especially good diagnostic standards.
In 1985-89 skin cancer mortality rates in men at all ages, as compared to 1970-74, were 33% higher in Italy and 46% higher in FVG. In women, there was a rise of 22% in Italy and 94% in FVG. More marked upward trends were observed in young and middle aged adults, especially among women in FVG (over 300% increase). In absolute terms, approximately 3000 more Italians died from skin cancers in 1985-89 as compared to 1970-74, about half of them prematurely (i.e., < 65 years). CMM was mentioned in death certifications for skin cancer increasingly often in all age groups, particularly in FVG.
The analysis of mortality trends from skin cancer is consistent with a substantial rise of CMM-related deaths. The sensitivity of death certification with respect to CMM diagnosis is also increasing, especially in FVG. A public health strategy with the aim of reducing intermittent intense exposure to ultraviolet light, especially in children, is urgent in Italy as CMM represents one of the few causes of premature death with unfavorable trends.
在过去二十年中，多数欧洲国家的皮肤癌死亡率呈现出显著的上升趋势。然而，基于死亡证明来区分皮肤恶性黑色素瘤（CMM）和非黑色素瘤性皮肤癌并不可靠。
为了评估CMM的趋势，将CMM的特定编码（国际疾病分类第八版和第九版：172）分析与全年龄段以及选定年龄组（15 - 44岁、45 - 64岁和65 - 84岁）的皮肤癌总死亡率分析相结合，后者以1981年意大利人口普查数据进行标准化。分析在意大利全国以及弗留利 - 威尼斯朱利亚大区（FVG）开展，该大区位于意大利东北部，肤色白皙者比例高，日光浴频率高，且诊断标准尤其完善。
与1970 - 1974年相比，1985 - 1989年意大利所有年龄段男性的皮肤癌死亡率高出33%，FVG高出46%。女性方面，意大利上升了22%，FVG上升了94%。在年轻人和中年人中观察到更为明显的上升趋势，尤其是FVG的女性（增幅超过300%）。从绝对数字来看，与1970 - 1974年相比，1985 - 1989年死于皮肤癌的意大利人多出约3000人，其中约一半为过早死亡（即<65岁）。各年龄组在皮肤癌死亡证明中提及CMM的频率越来越高，尤其是在FVG。
皮肤癌死亡率趋势分析与CMM相关死亡人数的大幅上升一致。死亡证明对CMM诊断的敏感度也在增加，尤其是在FVG。在意大利，迫切需要制定一项公共卫生策略，旨在减少尤其是儿童时期间歇性强烈暴露于紫外线，因为CMM是少数呈现不良趋势的过早死亡原因之一。
