Incidence and mortality trends of primary cutaneous melanoma: A 50-year Rochester Epidemiologic Project study.

BACKGROUND

National cancer reporting-based registry data, although robust, lacks granularity for incidence trends. Expert opinion remains conflicted regarding the possibility of melanoma overdiagnosis in the context of rising incidence without a corresponding rise in mortality.

OBJECTIVE

To characterize 10- and 50-year trends in melanoma incidence and mortality.

METHODS

Multicenter, population-based epidemiologic study utilizing the Rochester Epidemiology Project for Olmsted County, Minnesota residents diagnosed with melanoma from 01/01/1970 to 12/21/2020. Age- and sex-adjusted incidence and disease-specific mortality are calculated.

RESULTS

Two thousand three hundred ten primary cutaneous melanomas were identified. Current age- and sex-adjusted incidence rates increased 11.1-fold since 1970s ( < .001). Over the last decade, there is an overall 1.21-fold ( < .002) increase, with a 1.36-fold increase ( < .002) among females and no significant increase among males (1.09-fold increase,  < .329). Melanoma-specific mortality decreased from 26.7% in 1970s to 1.5% in 2010s, with a hazard ratio (HR) reduction of 0.73 ( < .001) per 5-year period. Increased mortality was associated with Breslow thickness (HR 1.35,  < .001), age at diagnosis (HR 1.13,  = .001) left anatomic site (HR 1.98,  = .016), and nodular histogenic subtype (HR 3.08,  < .001).

LIMITATIONS

Retrospective nature and focused geographic investigation.

CONCLUSION

Melanoma incidence has continued to increase over the past decade, most significantly in females aged 40+. Trend variations among age and sex cohorts suggests external factors beyond overdiagnosis may be responsible. Disease-specific mortality of melanoma continues to decrease over the last 50 years.