Incidence and mortality trends of primary cutaneous melanoma: A 50-year Rochester Epidemiologic Project study
Jacob P. Reinhart, Elliott H. Campbell, Sydney L. Proffer, Olivia M. Crum, Austin Todd, Lawrence E. Gibson, Jerry D. Brewer, Addison M. Demer
Abstract
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 ( P < .001). Over the last decade, there is an overall 1.21-fold ( P < .002) increase, with a 1.36-fold increase ( P < .002) among females and no significant increase among males (1.09-fold increase, P < .329). Melanoma-specific mortality decreased from 26.7% in 1970s to 1.5% in 2010s, with a hazard ratio (HR) reduction of 0.73 ( P < .001) per 5-year period. Increased mortality was associated with Breslow thickness (HR 1.35, P < .001), age at diagnosis (HR 1.13, P = .001) left anatomic site (HR 1.98, P = .016), and nodular histogenic subtype (HR 3.08, P < .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.